| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 738 N 1ST STREET, SUITE 202 SAN JOSE, CA 95112 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $24K | — | $24K | 7.92% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 738 N 1ST STREET, SUITE 202 SAN JOSE, CA 95112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $3K | $9K | 15.25% |
| ACRISURE LLC3 Filed as: FILICE INSURANCE AGENCY/ACRISURE | 26238 ENTERPRISE CT. LAKE FOREST, CA 92630 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO | $7K | — | $7K | 12.91% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 738 N 1ST STREET, SUITE 202 SAN JOSE, CA 95112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $700 | $2K | 15.24% |
| DAVID A. RACKLIFFE3 | 300 HEROIT CT SPRING HILL, TN 37174 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $703 | $9 | $712 | 15.28% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F. FAHEY III | 103 PALM DRIVE SAN CLEMENTE, CA 92672 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $293 | $142 | $435 | 9.33% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 738 N 1ST STREET, SUITE 202 SAN JOSE, CA 95112 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $427 | — | $427 | 9.16% |
| MIRIAM F HUNGERFORD3 Filed as: MIRIAM F. HUNGERFORD | 33622 HOLTZ HILL ROAD DANA POINT, CA 92629 | AFLAC | $94 | — | $94 | 6.19% |
| JOY E GUNDERSON3 Filed as: JOY E. GUNDERSON | 4531 VALLECITO LANE YORBA LINDA, CA 92886 | AFLAC | $25 | — | $25 | 1.65% |
| KENNETH FRANCIS O'ROURKE3 | P.O. BOX 1375 PLACENTIA, CA 92871 | AFLAC | $21 | — | $21 | 1.38% |
| DAVID A. BJORKLUND3 | 11 CALLE VECINO SAN CLEMENTE, CA 92673 | AFLAC | $15 | — | $15 | 0.99% |
| SCOTT W BLACKSHEAR3 Filed as: SCOTT W. BLACKSHEAR | 3453 CATHRYN DRIVE COLUMBUS, GA 31906 | AFLAC | $7 | — | $7 | 0.46% |
| MANA INSURANCE SOLUTIONS INC3 | PO BOX 930 MAKAWAO, HI 96768 | AFLAC | $3 | — | $3 | 0.20% |
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 | 398 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 405 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 363 | $302K |
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO | 668 | $54K |
| Life insurance(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 398 | $74K |
| Short-term disability(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 6 | $6K |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 398 | $77K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 668 | — |
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.