| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ROBERT JAMES KIDWELL3 | 1901 GOLDEN WAY MOUNTAIN VIEW, CA 94040 | AETNA LIFE INSURANCE CO. | $18K | — | $18K | 0.47% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | 13155 OLSON DRIVE SAN JOSE, CA 95117 | AETNA LIFE INSURANCE CO. | $6K | — | $6K | 0.16% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E. HAMILTON AVE.#500 CAMPBELL, CA 95008 | AETNA LIFE INSURANCE CO. | $6K | — | $6K | 0.15% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E HAMILTON AVE, SUITE 500 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $2K | $7K | 7.57% |
| ROB KIDWELL3 | 1901 GOLDEN WAY MOUNTAIN VIEW, CA 94040 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 5.00% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E HAMILTON AVE, SUITE 500 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $5K | 7.55% |
| ROB KIDWELL3 | 1901 GOLDEN WAY MOUNTAIN VIEW, CA 94040 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 5.00% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E HAMILTON AVE, SUITE 500 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $631 | $2K | 7.60% |
| ROB KIDWELL3 | 1901 GOLDEN WAY MOUNTAIN VIEW, CA 94040 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 5.00% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E HAMILTON AVE, SUITE 500 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $647 | $2K | 7.80% |
| ROB KIDWELL3 | 1901 GOLDEN WAY MOUNTAIN VIEW, CA 94040 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 5.00% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E HAMILTON AVE, SUITE 500 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $583 | $2K | 7.63% |
| ROB KIDWELL3 | 1901 GOLDEN WAY MOUNTAIN VIEW, CA 94040 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 5.00% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E HAMILTON AVE, SUITE 500 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $988 | $591 | $2K | 7.99% |
| ROB KIDWELL3 | 1901 GOLDEN WAY MOUNTAIN VIEW, CA 94040 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $988 | — | $988 | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| FILICE INSURANCE SERVICES, LLC BROKER | Insurance agents and brokers Service code 22 | 900 E. HAMILTON AVENUE CAMPBELL, CA 95008 | $29K |
| ACISURE PARTNERS WEST COAST, LLC BROKER | Insurance agents and brokers Service code 22 | 3155 OLSEN DRIVE SAN JOSE, CA 95008 | $26K |
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 | 359 | 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) | 359 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE CO. | 657 | $3.8M |
| Dental | AETNA LIFE INSURANCE CO. | 657 | $3.8M |
| Vision | AETNA LIFE INSURANCE CO. | 657 | $3.8M |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 359 | $111K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 359 | $24K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 359 | $62K |
| Other(4 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 359 | $153K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 657 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.