| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FILICE INSURANCE AGENCY3 Filed as: RON FILICE ENTERPRISES INC | 738 N 1ST ST SAN JOSE, CA 95112 | CALIFORNIA PHYSICIANS' SERVICE | $0 | $23K | $23K | 3.24% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INSURANCE | 6200 CANOGA AVE STE 300 WOODLAND HILLS, CA 91367 | CALIFORNIA PHYSICIANS' SERVICE | $15K | $0 | $15K | 2.08% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 500 N SANTA FE VISALIA, CA 93292 | CALIFORNIA PHYSICIANS' SERVICE | $0 | $7K | $7K | 1.02% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 738 N 1ST ST STE 202 SAN JOSE, CA 95112 | KAISER FOUNDATION HEALTH PLAN INC | $0 | $484 | $484 | 0.09% |
| ALLIANT INSURANCE SERVICES, INC.3 Filed as: ALLIANT INSURANCE SERVICES INC | — | DELTA DENTAL OF CALIFORNIA | $3K | $0 | $3K | 3.27% |
| FILICE INSURANCE AGENCY3 Filed as: RON FILICE ENTERPRISES | — | DELTA DENTAL OF CALIFORNIA | $2K | $0 | $2K | 1.65% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | — | DELTA DENTAL OF CALIFORNIA | $861 | $0 | $861 | 0.82% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLGHER BENEFIT SERVICES INC | — | DELTA DENTAL OF CALIFORNIA | $829 | $0 | $829 | 0.79% |
| FILICE INSURANCE AGENCY3 Filed as: RON FILICE ENTERPRISES INC | 738 N 1ST ST SAN JOSE, CA 95112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $4K | $9K | 16.11% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 505 N BRAND BLVD FL 6 GLENDALE, CA 91203 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $0 | $1K | 1.95% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 GOLF RD ROLLING MEADOWS, IL 60008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $1K | $1K | 1.95% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 738 N 1ST ST SAN JOSE, CA 95112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $482 | $0 | $482 | 0.90% |
| FILICE INSURANCE AGENCY3 Filed as: RON FILICE ENTERPRISES | 738 N 1ST ST STE 202 SAN JOSE, CA 95112 | VISION SERVICE PLAN | $886 | $0 | $886 | 5.99% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE | — | CONCERN EAP | $375 | $0 | $375 | 5.00% |
| FILICE INSURANCE AGENCY3 Filed as: RON FILICE ENTERPRISES INC | 738 N 1ST ST SAN JOSE, CA 95112 | BLUE SHIELD OF CALIFORNIA LIFE & HEALTH INSURANCE COMPANY | $388 | $0 | $388 | 8.13% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INSURANCE | 6200 CANOGA AVE STE 300 WOODLAND HILLS, CA 91367 | BLUE SHIELD OF CALIFORNIA LIFE & HEALTH INSURANCE COMPANY | $95 | $0 | $95 | 1.99% |
| GALLAGHER BENEFIT SERVICES, INC.3 | 500 N SANTA FE VISALIA, CA 93292 | BLUE SHIELD OF CALIFORNIA LIFE & HEALTH INSURANCE COMPANY | $89 | $0 | $89 | 1.87% |
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 | 101 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 106 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 85 | $1.3M |
| Dental | DELTA DENTAL OF CALIFORNIA | 194 | $104K |
| Vision | VISION SERVICE PLAN | 81 | $15K |
| Life insurance(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 101 | $58K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 101 | $54K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 101 | $54K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 85 | $719K |
| Other(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 110 | $66K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 194 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.