| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CASSIDY O'HARA3 | 1123 CHERRY AVENUE SAN JOSE, CA 95125 | METROPOLITAN LIFE INSURANCE COMPANY | $17K | $4K | $21K | 12.38% |
| O'HARA, CASSIDY E3 | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $10K | $2K | $11K | 10.03% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $555 | $3K | 2.93% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | VISION SERVICE PLAN | $1K | — | $1K | 3.40% |
| O'HARA, CASSIDY E3 | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $489 | $3K | 10.05% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $717 | $143 | $860 | 2.94% |
| O'HARA, CASSIDY E3 Filed as: O'HARA, CASSIDY EVAN | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $811 | $81 | $892 | 16.50% |
| O'HARA, CASSIDY E3 Filed as: O'HARA, CASSIDY EVAN | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $208 | $17 | $225 | 16.21% |
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 | 158 | 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) | 159 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF ALABAMA | 413 | $2.0M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 588 | $169K |
| Vision | VISION SERVICE PLAN | 163 | $43K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 137 | $114K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 137 | $114K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 137 | $114K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF ALABAMA | 413 | $2.0M |
| Other(5 contracts, 3 carriers) | BLUE CROSS AND BLUE SHIELD OF ALABAMA | 413 | $2.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 588 | — |
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.