| 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. | $39K | — | $39K | 2.79% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 738 N 1ST ST STE 202 SAN JOSE, CA 95112 | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF COLUMBUS | $8K | — | $8K | 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 | $1K | $676 | $2K | 7.60% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $92 | — | $92 | 0.41% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES | 900 E HAMILTON AVE. CAMPBELL, CA 95008 | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | $935 | — | $935 | 7.15% |
| PROFESSIONAL GROUP PLANS INC3 Filed as: PROFESSIONAL GROUP PLANS | 225 WIRELESS BLVD. HAUPPAUGE, NY 11788 | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | — | $599 | $599 | 4.58% |
| ACRISURE LLC3 Filed as: ACRISURE WEST INSURANCE SERVICES | 3155 OLSEN DR STE 400 SAN JOSE, CA 95117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $741 | $244 | $985 | 12.23% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $65 | — | $65 | 0.81% |
| ACRISURE LLC3 Filed as: ACRISURE WEST INSURANCE SERVICES | 3155 OLSEN DR STE 400 SAN JOSE, CA 95117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $576 | $2K | — |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $195 | — | $195 | — |
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 | 125 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 125 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 215 | $1.4M |
| Dental | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | 112 | $13K |
| Vision | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | 112 | $13K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 125 | $8K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 125 | $22K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 215 | $1.4M |
| Other(2 contracts, 2 carriers) | AMERICAN FAMILY LIFE ASSURANCE COMPANY OF COLUMBUS | 137 | $90K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 215 | — |
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.