| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | STANDARD INSURANCE COMPANY | $16K | — | $16K | 10.00% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | STANDARD INSURANCE COMPANY | $4K | — | $4K | 2.64% |
| 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 | $15K | $3K | $18K | 12.00% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | VISION SERVICE PLAN | $5K | — | $5K | 9.95% |
| 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 | $621 | $4K | 12.00% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | STANDARD INSURANCE COMPANY | $881 | — | $881 | 10.00% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | STANDARD INSURANCE COMPANY | $608 | — | $608 | 6.90% |
| 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 | $316 | $3 | $319 | 15.13% |
| 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 | $99 | — | $99 | 15.00% |
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 | 202 | 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) | 203 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS AND BLUE SHIELD OF ALABAMA | 499 | $2.2M |
| Dental | STANDARD INSURANCE COMPANY | 200 | $163K |
| Vision(2 contracts, 2 carriers) | VISION SERVICE PLAN | 205 | $59K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 202 | $150K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 202 | $150K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 202 | $150K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF ALABAMA | 499 | $2.2M |
| Other(5 contracts, 3 carriers) | BLUE CROSS AND BLUE SHIELD OF ALABAMA | 499 | $2.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 499 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.