| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 1150 MORAGA WAY MORAGA, CA 94556 | SUTTER HEALTH PLAN | $26K | — | $26K | 3.39% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS. | 3155 OLSEN DRIVE, STE.400 ACTION DAY NURSERIES/PRIMARY PLUS SAN JOSE, CA 95117 | SUTTER HEALTH PLAN | $13K | — | $13K | 1.61% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E. HAMILTON AVE.#500 CAMPBELL, CA 95008 | KAISER FOUNDATION HEALTH PLAN INC | $8K | — | $8K | 4.03% |
| ACRISURE LLC3 Filed as: ACRISURE WEST | 900 E. HAMILTON AVE.#500 CAMPBELL, CA 95008 | CYPRESS DENTAL ADMINISTRATORS | $7K | — | $7K | 6.67% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 900 E. HAMILTON AVE.#500 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $2K | $6K | 14.57% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS. | 3155 OLSEN DRIVE, STE.400 ACTION DAY NURSERIES/PRIMARY PLUS SAN JOSE, CA 95117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $345 | — | $345 | 0.80% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 900 E. HAMILTON AVE.#500 CAMPBELL, CA 95008 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $1K | — | $1K | 10.92% |
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 | 108 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 112 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | SUTTER HEALTH PLAN | 108 | $982K |
| Dental | CYPRESS DENTAL ADMINISTRATORS | 92 | $104K |
| Vision | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 71 | $13K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 93 | $43K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 93 | $43K |
| Prescription drug(2 contracts, 2 carriers) | SUTTER HEALTH PLAN | 108 | $982K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 93 | $43K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 108 | — |
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.