| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE | 1150 MORAGA WAY MORAGA, CA 94556 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $4K | $4K | 4.98% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E. HAMILTON AVE.#500 CAMPBELL, CA 95008 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $5K | — | $5K | 20.00% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E. HAMILTON AVE.#500 CAMPBELL, CA 95008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 21.82% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| TELUS HEALTH (US) LTD. EIN 52-1883918 EAP | Investment management fees paid indirectly by plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Claims processing Service code 12 | 250 ROYALL STREET, SUITE 210 W CANTON, MA 02021 | $5K |
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 | 219 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 220 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 183 | $1.0M |
| Dental(2 contracts) | DELTA DENTAL OF CALIFORNIA | 168 | $30K |
| Vision | VISION SERVICE PLAN | 164 | $24K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 213 | $80K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 213 | $80K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 183 | $1.0M |
| Other(6 contracts, 5 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 223 | $163K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 223 | — |
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.
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.