| 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 | 2.96% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | PRINCIPAL LIFE INSURANCE COMPANY | $4K | — | $4K | 4.35% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $4K | — | $4K | 13.11% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 94901 | CALIFORNIA DENTAL NETWORK | $548 | — | $548 | 9.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DIRECT DENTAL ADMINISTRATORS, LLC EIN 94-3270798 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 700 LARKSPUR LANDING CIR., STE.199 LARKSPUR, CA 94939 | $10K |
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 | 191 | 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) | 191 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 175 | $1.1M |
| Dental(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 155 | $101K |
| Life insurance(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 191 | $33K |
| Long-term disability(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 191 | $33K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN, INC. | 175 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 191 | — |
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.