| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | KAISER FOUNDATION HEALTH PLAN INC | $42K | — | $42K | 4.97% |
| ACRISURE LLC3 Filed as: ACRISURE WEST INSURANCE SERVICES | 3155 OLSEN DRIVE SUITE 400 SAN JOSE, CA 95117 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $18K | $2K | $20K | 10.85% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $669 | $4K | 19.25% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $588 | $4K | 19.22% |
| MICHAEL EDWARD CHAVEZ3 | 738 N 1ST ST, STE 202 SAN JOSE, CA 95112 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 13.91% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | UNUM INSURANCE COMPANY | $2K | $444 | $2K | 18.48% |
| GIS NATIONAL3 Filed as: GIS NORTHERN CALIFORNIA | 315 MONTGOMERY ST SUITE 900 SAN FRANCISCO, CA 94104 | METLIFE LEGAL PLANS | $920 | — | $920 | 14.93% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | METLIFE LEGAL PLANS | $624 | — | $624 | 10.12% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS3 Filed as: BOON-CHAPMAN BENEFIT ADMINISTRATORS | PO BOX 9201 BLDG, SUITE 100 AUSTIN, TX 78766 | METLIFE LEGAL PLANS | — | $428 | $428 | 6.94% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 E HAMILTON AVE SUITE 500 CAMPBELL, CA 95008 | METLIFE LEGAL PLANS | $211 | — | $211 | 3.42% |
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 | 140 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 141 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 142 | $843K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 138 | $184K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 285 | $21K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 87 | $19K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 43 | $22K |
| Other(4 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 87 | $52K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 285 | — |
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.