| 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 | $33K | — | $33K | 2.59% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | KAISER FOUNDATION HEALTH PLAN INC | $15K | $1 | $15K | 1.21% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | 3155 OLSEN DR STE 400 SAN JOSE, CA 95117 | SUTTER HEALTH PLAN | $32K | — | $32K | 5.00% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INSURA | 2700 ZANKER ROAD, SUITE 150 SAN JOSE, CA 95134 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $7K | $603 | $7K | 16.06% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $1K | $1K | 2.71% |
| ACRISURE LLC3 Filed as: ACRISURE PTNRS WEST COAST INS SVCS | 3155 OLSEN DR, STE 400 SAN JOSE, CA 95117 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | — | $3K | 10.00% |
| ACRISURE LLC3 Filed as: ACRISURE PTNRS WEST COAST INS SVCS | 3155 OLSEN DR STE 400 SAN JOSE, CA 95117 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| ACRISURE LLC3 Filed as: ACRISURE PTNRS WEST COAST INS SVCS | 3155 OLSEN DR, STE 400 SAN JOSE, CA 95117 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $880 | — | $880 | 10.00% |
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 | 174 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 174 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 140 | $1.9M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 200 | $44K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 200 | $44K |
| Life insurance | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 241 | $9K |
| Short-term disability | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 240 | $17K |
| Long-term disability | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 241 | $27K |
| Prescription drug | SUTTER HEALTH PLAN | 70 | $633K |
| Other | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 241 | $9K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 241 | — |
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."
No prospect flags tripped on this filing.