| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E HAMILTON AVE, SUITE 500 CAMPBELL, CA 95008 | KAISER FOUNDATION HEALTH PLAN, INC | $123K | $5 | $123K | 3.83% |
| FILICE INSURANCE AGENCY3 | 1150 MORAGA WAY MORAGA, CA 94556 | SUTTER HEALTH PLAN | $25K | — | $25K | 5.00% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 1150 MORAGA WAY MORAGA, CA 94556 | HOMETOWN HEALTH | $23K | — | $23K | 5.50% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | RELIASTAR LIFE INSURANCE COMPANY | $24K | — | $24K | 12.62% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 1150 MORAGA WAY MORAGA, CA 94556 | HOMETOWN HEALTH | $6K | — | $6K | 5.50% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E HAMILTON AVE, SUITE 500 CAMPBELL, CA 95008 | VISION SERVICE PLAN | $5K | — | $5K | 9.15% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MULTIBENEFIT SERVICES WEST EIN 36-4104766 NONE | Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | — | $138K |
| FILICE INSURANCE SERVICES, LLC EIN 84-2930139 NONE | Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | — | $60K |
| STAR MARKETING AND ADMINISTRATION EIN 36-3403079 NONE | Claims processing; Plan Administrator; Other services Service code 12 | — | -$72K |
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 410 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 410 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN, INC | 410 | $4.3M |
| Dental | DELTA DENTAL OF CALIFORNIA | 276 | $338K |
| Vision | VISION SERVICE PLAN | 304 | $51K |
| Life insurance | RELIASTAR LIFE INSURANCE COMPANY | 348 | $188K |
| Short-term disability | RELIASTAR LIFE INSURANCE COMPANY | 348 | $188K |
| Long-term disability | RELIASTAR LIFE INSURANCE COMPANY | 348 | $188K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC | 410 | $3.7M |
| Other | RELIASTAR LIFE INSURANCE COMPANY | 348 | $188K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 410 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
No prospect flags tripped on this filing.