| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 738 NORTH FIRST STREET SAN JOSE, CA 95112 | BLUE SHIELD OF CALIFORNIA - CALIFORNIA PHYSICIANS' SERVICE | — | $133K | $133K | 5.30% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES, | 1600 W HILLSDALE BLVD SUITE 201 SAN MATEO, CA 94402 | BLUE SHIELD OF CALIFORNIA - CALIFORNIA PHYSICIANS' SERVICE | — | $53K | $53K | 2.11% |
| FILICE INSURANCE AGENCY3 | 738 N FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $12K | $818 | $13K | 10.66% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 738 N FIRST STREET SAN JOSE, CA 95112 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
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 | 117 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 117 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE SHIELD OF CALIFORNIA - CALIFORNIA PHYSICIANS' SERVICE | 230 | $2.5M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 111 | $123K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 115 | $20K |
| Prescription drug | BLUE SHIELD OF CALIFORNIA - CALIFORNIA PHYSICIANS' SERVICE | 230 | $2.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 230 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.