| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MDX FINANCIAL SERVICES, INC.3 Filed as: MDX FINANCIAL & INSURANCE SERVICES | 8175 E BROOKDALE LN ANAHEIM, CA 92807 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO | $4K | — | $4K | 6.58% |
| 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 | $3K | — | $3K | 5.12% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE-LAKE FOREST, CA | 738 NORTH FIRST ST USE #2026276 SAN JOSE, CA 95112 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO | $659 | — | $659 | 1.21% |
| MDX FINANCIAL SERVICES, INC.3 | 8175 E BROOKDALE LN ANAHEIM, CA 92807 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 6.32% |
| 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 | $2K | — | $2K | 3.68% |
| MDX FINANCIAL SERVICES, INC.3 | 8175 E BROOKDALE LN ANAHEIM, CA 92807 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $822 | — | $822 | 6.43% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 738 N 1ST STREET SAN JOSE, CA 95112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $456 | — | $456 | 3.57% |
| DAVID A. RACKLIFFE3 | 300 HEROIT CT SPRING HILL, TN 37174 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $780 | $6 | $786 | 10.16% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 E. HAMILTON AVE CAMPBELL, CA 95008 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $652 | — | $652 | 8.43% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F. FAHEY III | 103 PALM DRIVE SAN CLEMENTE, CA 92672 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $345 | $116 | $461 | 5.96% |
| MIRIAM F HUNGERFORD3 Filed as: MIRIAM F. HUNGERFORD | 33622 HOLTZ HILL ROAD DANA POINT, CA 92629 | AFLAC | $72 | — | $72 | 6.46% |
| JOY E GUNDERSON3 Filed as: JOY E. GUNDERSON | 2824 SAINT ANDREWS RD FAIRFIELD, CA 94534 | AFLAC | $19 | — | $19 | 1.70% |
| KENNETH FRANCIS O'ROURKE3 | P.O. BOX 1375 PLACENTIA, CA 92871 | AFLAC | $15 | — | $15 | 1.35% |
| DAVID A. BJORKLUND3 | 11 CALLE VECINO SAN CLEMENTE, CA 92673 | AFLAC | $11 | — | $11 | 0.99% |
| SCOTT W BLACKSHEAR3 Filed as: SCOTT W. BLACKSHEAR | 108 ALSACE CT PONTE VERDA BEACH, FL 32082 | AFLAC | $5 | — | $5 | 0.45% |
| CHRIS BRANSON3 | PO BOX 930 MAKAWAO, HI 96768 | AFLAC | $2 | — | $2 | 0.18% |
| MANA INSURANCE SOLUTIONS INC3 | PO BOX 930 MAKAWAO, HI 96768 | AFLAC | $1 | — | $1 | 0.09% |
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 | 348 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 11 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 359 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO | 599 | $55K |
| Life insurance(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 348 | $65K |
| Short-term disability(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 6 | $9K |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 348 | $72K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 599 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.