| 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. | $31K | — | $31K | 2.24% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS | SERVICES 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | KAISER FOUNDATION HEALTH PLAN, INC. | $26K | $1 | $26K | 1.83% |
| ACRISURE LLC3 Filed as: ACRISURE WEST INSURANCE SERVICES | 900 E HAMILTON AVE SUITE 500 CAMPBELL, CA 95008 | BLUE CROSS OF CALIFORNIA | $8K | — | $8K | 4.47% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 2677 N MAIN STREET SANTA ANA, CA 92705 | BLUE CROSS OF CALIFORNIA | — | $4K | $4K | 2.41% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | BLUE CROSS OF CALIFORNIA | $629 | — | $629 | 0.35% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS | 2700 ZANKER ROAD SUITE 150 SAN JOSE, CA 95134 | GUARDIAN | $7K | $4K | $11K | 16.25% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | INS SVC LLC 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | ANTHEM LIFE INSURANCE COMPANY | $172 | — | $172 | 6.93% |
| AMWINS3 Filed as: AMWINS CONNECT INS SVCS LLC | 1600 W HILLSDALE BLVD SAN MATEO, CA 94402 | ANTHEM LIFE INSURANCE COMPANY | $57 | $48 | $105 | 4.23% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | ANTHEM LIFE INSURANCE COMPANY | $38 | — | $38 | 1.53% |
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 | 111 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 115 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 272 | $1.6M |
| Dental(2 contracts, 2 carriers) | GUARDIAN | 73 | $70K |
| Vision | GUARDIAN | 73 | $68K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 8 | $2K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 272 | — |
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."
No prospect flags tripped on this filing.