| 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 | BLUE CROSS OF CALIFORNIA | $36K | — | $36K | 3.78% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | — | BLUE CROSS OF CALIFORNIA | — | $21K | $21K | 2.24% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS SE | 900 EAST HAMILTON AVENUE SUITE 500 CAMPBELL, CA 95008 | BLUE CROSS OF CALIFORNIA | $11K | — | $11K | 1.19% |
| FILICE INSURANCE AGENCY3 Filed as: FILLICE INSURANCE SERVICES LLC | 900 E HAMILTON AVE SUITE 500 CAMPBELL, CA 950080667 | KAISER FOUNDATION HEALTH PLAN | $12K | — | $12K | 2.56% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST INS SERVS | 3155 OLSEN DR STE 400 SAN JOSE, CA 951171685 | PRINCIPAL LIFE INSURANCE COMPANY | $19K | — | $19K | 8.50% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SVCS | ATTN ACCOUNTING DEPT. 32110 AGOURA RD WESTLAKE VILLAGE, CA 913614026 | PRINCIPAL LIFE INSURANCE COMPANY | — | $14K | $14K | 6.34% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 950080643 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | $3K | $5K | 2.16% |
| ACRISURE LLC3 Filed as: ACRISURE, LLC | PO BOX 1788 GRAND RAPIDS, MI 495011788 | PRINCIPAL LIFE INSURANCE COMPANY | — | $1K | $1K | 0.55% |
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 | 112 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 113 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 67 | $1.4M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 184 | $223K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 184 | $223K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 184 | $223K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 184 | $223K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 184 | $223K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 184 | — |
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.