| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E. HAMILTON AVE.#500 CAMPBELL, CA 950080667 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $73K | — | $73K | 4.34% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS. | 900 E. HAMILTON AVE.#500 CAMPBELL, CA 95008 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $17K | — | $17K | 0.99% |
| FILICE INSURANCE AGENCY3 | 738 NORTH FIRST STREET SAN JOSE, CA 95112 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | — | $3K | $3K | 0.17% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E. HAMILTON AVE.#500 CAMPBELL, CA 95008 | STANDARD INSURANCE COMPANY | $3K | $666 | $4K | 8.20% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS. | 900 E. HAMILTON AVE.#500 CAMPBELL, CA 95008 | STANDARD INSURANCE COMPANY | $952 | — | $952 | 2.22% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS. | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | VISION SERVICE PLAN | $2K | — | $2K | 9.18% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E HAMILTON AVE, SUITE 500 CAMPBELL, CA 95008 | VISION SERVICE PLAN | $203 | — | $203 | 0.82% |
| DC RISK SOLUTIONS3 | PO BOX 14817 SAN FRANCISCO, CA 94114 | VISION SERVICE PLAN | -$150 | — | -$150 | -0.60% |
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 | 181 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 181 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 178 | $1.7M |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 178 | $1.7M |
| Vision | VISION SERVICE PLAN | 147 | $25K |
| Life insurance(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 181 | $1.7M |
| Short-term disability | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 178 | $1.7M |
| Long-term disability(2 contracts, 2 carriers) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 181 | $1.7M |
| Other | STANDARD INSURANCE COMPANY | 181 | $43K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 181 | — |
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.