| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FILICE INSURANCE AGENCY3 | 900 E HAMILTON AVE. CAMPBELL, CA 95008 | KAISER FOUNDATION HEALTH PLAN INC. | $144K | — | $144K | 4.03% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | 100 OTTAWA AVENUE GRAND RAPIDS, MI 49503 | KAISER FOUNDATION HEALTH PLAN INC. | $43K | $2 | $43K | 1.20% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | 3155 OLSEN DRIVE SAN JOSE, CA 95117 | SUTTER HEALTH PLAN | $20K | — | $20K | 4.23% |
| FILICE INSURANCE AGENCY3 | 1150 MORAGA WAY MORAGA, CA 94556 | SUTTER HEALTH PLAN | $4K | — | $4K | 0.77% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | 100 OTTAWA AVE. GRAND RAPIDS, MI 49503 | VISION SERVICE PLAN | $5K | — | $5K | 10.01% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | 2700 ZANKER ROAD SAN JOSE, CA 95134 | GUARDIAN | $6K | $726 | $6K | 20.00% |
| FILICE INSURANCE AGENCY3 | 3155 OLSEN DRIVE SAN JOSE, CA 95112 | HARTFORD LIFE & ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 15.01% |
| GROUP BENEFITS LTD3 | 12006 RIDGEMONT DRIVE URBANDALE, IA 50323 | HARTFORD LIFE & ACCIDENT INSURANCE COMPANY | — | $1K | $1K | 12.49% |
| ACRISURE LLC3 | 100 OTTAWA AVE. GRAND RAITS, MI 49503 | HARTFORD LIFE & ACCIDENT INSURANCE COMPANY | — | $115 | $115 | 1.25% |
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 | 365 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 366 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 420 | $4.1M |
| Vision | VISION SERVICE PLAN | 277 | $54K |
| Life insurance | HARTFORD LIFE & ACCIDENT INSURANCE COMPANY | 360 | $9K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 420 | $4.1M |
| Other(3 contracts, 3 carriers) | GUARDIAN | 365 | $58K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 420 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.