| 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 | BLUE SHIELD OF CALIFORNIA - CALIFORNIA PHYSICIANS' SERVICE | — | $32K | $32K | 5.26% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $6K | — | $6K | 10.00% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | KAISER FOUNDATION HEALTH PLAN INC | $3K | — | $3K | 5.46% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $938 | — | $938 | 10.00% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $601 | — | $601 | 10.00% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 20.01% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $477 | — | $477 | 10.00% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $321 | — | $321 | 10.01% |
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 | 137 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 140 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA - CALIFORNIA PHYSICIANS' SERVICE | 318 | $667K |
| Dental | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 523 | $63K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 523 | $63K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 137 | $5K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 137 | $3K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 137 | $9K |
| Prescription drug(2 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA - CALIFORNIA PHYSICIANS' SERVICE | 318 | $667K |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 137 | $17K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 523 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.