| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE WEST INSURANCE SERVICES | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | BLUE CROSS OF CALIFORNIA | $222K | — | $222K | 4.05% |
| ACRISURE LLC3 | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | BLUE CROSS OF CALIFORNIA | — | $5K | $5K | 0.10% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | KAISER FOUNDATION HEALTH PLAN INC | $46K | $1 | $46K | 2.92% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | KAISER FOUNDATION HEALTH PLAN INC | $33K | — | $33K | 2.07% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | 3155 OLSEN DR STE 400 SAN JOSE, CA 95117 | AMERITAS | $52K | — | $52K | 10.00% |
| ACRISURE LLC3 Filed as: ACRISURE WEST INSURANCE SERVICES | 3155 OLSEN DR, STE 400 SAN JOSE, CA 95117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | $7K | $13K | 5.32% |
| ACRISURE LLC3 Filed as: ACRISURE WEST INSURANCE SERVICES | 3155 OLSEN DR, STE 400 SAN JOSE, CA 95117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | $2K | $11K | 12.46% |
| ACRISURE LLC3 Filed as: ACRISURE WEST INSURANCE SERVICES | 3155 OLSEN DR, STE 400 SAN JOSE, CA 95117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $2K | $7K | 8.77% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | 100 OTTAWA AVE, SW GRAND RAPIDS, MI 49503 | VISION SERVICE PLAN | $5K | — | $5K | 10.82% |
| ACRISURE LLC3 Filed as: ACRISURE NORTHWEST PARTNERS INS | 40TH AVE W SUITE 440 LYNNWOOD, WA 98036 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $1K | — | $1K | 3.00% |
| ACRISURE LLC3 Filed as: ACRISURE WEST INSURANCE SERVICES | 3155 OLSEN DR STE 400 SAN JOSE, CA 95117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $733 | $3K | 12.81% |
| ACRISURE LLC3 Filed as: ACRISURE WEST INSURANCE SERVICES | 3155 OLSEN DR STE 400 SAN JOSE, CA 95117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $625 | $3K | 12.71% |
| ACRISURE LLC3 Filed as: ACRISURE WEST INSURANCE SERVICES | 3155 OLSEN DR STE 400 SAN JOSE, CA 95117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $562 | $3K | 12.65% |
| FILICE INSURANCE AGENCY3 Filed as: RON FILICE ENTERPRISES, INC. | 738 N FIRST ST STE 210 SAN JOSE, CA 95112 | NATIONAL UNION FIRE INS. CO. OF PITTSBURGH | $0 | — | $0 | — |
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 | 461 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 463 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 533 | $7.1M |
| Dental | AMERITAS | 732 | $516K |
| Vision | VISION SERVICE PLAN | 328 | $44K |
| Life insurance(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 466 | $382K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 466 | $21K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 466 | $82K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 171 | $1.6M |
| Other(4 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 466 | $300K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 732 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.