| 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. | $16K | — | $16K | 1.62% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | KAISER FOUNDATION HEALTH PLAN, INC. | $7K | — | $7K | 0.73% |
| FILICE INSURANCE AGENCY3 | 738 N 1ST ST STE 202 SAN JOSE, CA 95112 | KAISER FOUNDATION HEALTH PLAN, INC. | $217 | — | $217 | 0.02% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | HEALTH NET | $6K | — | $6K | 6.35% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | 2700 ZANKER ROAD, SUITE 150 SAN JOSE, CA 95134 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $4K | $3K | $7K | 11.55% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $6K | $6K | 10.73% |
| ANONYMOUS3 | — | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $240 | $240 | 0.41% |
| ENROLLEASE3 | 660 YORK STREET SUITE 102 SAN FRANCISCO, CA 94110 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $104 | — | $104 | 0.18% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $672 | $302 | $974 | 10.05% |
| ACRISURE LLC3 Filed as: ACRISURE WEST INSURANCE SERVICES, L | 3155 OLSEN DR STE 400 SAN JOSE, CA 95117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $297 | — | $297 | 3.07% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $653 | $292 | $945 | 9.97% |
| ACRISURE LLC3 Filed as: ACRISURE WEST INSURANCE SERVICES, L | 3155 OLSEN DR STE 400 SAN JOSE, CA 95117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $295 | — | $295 | 3.11% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $619 | $318 | $937 | 16.11% |
| ACRISURE LLC3 Filed as: ACRISURE WEST INSURANCE SERVICES, L | 3155 OLSEN DR STE 400 SAN JOSE, CA 95117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $254 | — | $254 | 4.37% |
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 | 106 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 106 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 103 | $1.1M |
| Dental(2 contracts, 2 carriers) | HEALTH NET | 82 | $146K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 82 | $59K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 35 | $9K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 5 | $6K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 35 | $10K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 35 | $9K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 103 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.