| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | KAISER FOUNDATION HEALTH PLAN INC | $34K | — | $34K | 1.28% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 3716 NORFOLK, VA 23514 | KAISER FOUNDATION HEALTH PLAN INC | $21K | — | $21K | 0.80% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | DELTA DENTAL OF CALIFORNIA | $8K | — | $8K | 3.30% |
| DDC BROKER - DIGITAL INSURANCE3 Filed as: DDC BROKER - NORTHERN CALIFORNIA | — | DELTA DENTAL OF CALIFORNIA | $3K | — | $3K | 1.45% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES - N. CALIF. | — | DELTA DENTAL OF CALIFORNIA | $2K | — | $2K | 0.75% |
| USI INSURANCE SERVICES LLC3 Filed as: KIBBLE & PRENTICE HOLDING - DB | P.O. BOX 62949 VIRGINIA BEACH, VA 23466 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $105 | $1K | 5.74% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $850 | $231 | $1K | 4.22% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | VISION SERVICE PLAN | $44 | — | $44 | 6.62% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 101 W. MAIN STREET, SUITE 900 NORFOLK, VA 23510 | VISION SERVICE PLAN | $22 | — | $22 | 3.31% |
No Schedule C service providers reported on this filing.
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 | 534 | 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) | 534 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 534 | $2.6M |
| Dental | DELTA DENTAL OF CALIFORNIA | 144 | $235K |
| Vision | VISION SERVICE PLAN | 5 | $665 |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 382 | $26K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 534 | $2.6M |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 382 | $26K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 534 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.