| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN, INC. | $62K | $0 | $62K | 2.21% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 EAST HAMILTON AVENUE SUITE 500 CAMPBELL, CA 95008 | KAISER FOUNDATION HEALTH PLAN, INC. | $29K | $0 | $29K | 1.05% |
| USI INSURANCE SERVICES LLC3 | 575 MARKET STREET, 37TH FLOOR SAN FRANCISCO, CA 94105 | SUTTER HEALTH PLAN | $16K | $0 | $16K | 2.69% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS. | 3155 OLSEN DRIVE, SUITE 400 SAN JOSE, CA 95117 | SUTTER HEALTH PLAN | $5K | $0 | $5K | 0.81% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 1150 MORAGA WAY MORAGA, CA 94556 | METROPOLITAN LIFE INSURANCE COMPANY | $10K | $5K | $15K | 3.49% |
| ASSUREDPARTNERS3 Filed as: ASSURED PARTNERS OF HOUSTON, LLC | 13750 SAN PEDRO AVENUE, SUITE 550 SAN ANTONIO, TX 78232 | METROPOLITAN LIFE INSURANCE COMPANY | $14K | $630 | $15K | 3.43% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | METROPOLITAN LIFE INSURANCE COMPANY | $12K | $2K | $15K | 3.40% |
| ACCRETIVE ENROLLMENT SERVICES LLC3 Filed as: ACCRETIVE ENROLLMENT SERVICES, LLC | 13750 SAN PEDRO AVENUE, SUITE 550 SAN ANTONIO, TX 78232 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | $0 | $5K | 1.20% |
| ACCRETIVE ENROLLMENT SERVICES LLC3 Filed as: ACCRETIVE ENROLLMENT SERVICES, LLC | 27064 OAKMEAD DRIVE PERRYSBURG, OH 43551 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $372 | $372 | 0.09% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62939 VIRGINIA BEACH, VA 23466 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $2 | $2 | 0.00% |
| USI INSURANCE SERVICES LLC3 | 575 MARKET STREET, SUITE 3750 SAN FRANCISCO, CA 94105 | CHINESE COMMUNITY HEALTH PLAN | $13K | $0 | $13K | 3.75% |
| FILICE INSURANCE AGENCY3 | 738 NORTH FIRST STREET, SUITE 202 SAN JOSE, CA 95112 | CHINESE COMMUNITY HEALTH PLAN | $4K | $0 | $4K | 1.25% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 EAST HAMILTON AVENUE SUITE 500 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $7K | $10K | 8.34% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | $0 | $9K | 7.22% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $2K | $0 | $2K | 7.49% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | 100 OTTAWA AVENUE SW GRAND RAPIDS, MI 49503 | VISION SERVICE PLAN | $378 | $0 | $378 | 1.68% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 EAST HAMILTON AVENUE SUITE 500 CAMPBELL, CA 95008 | VISION SERVICE PLAN | $192 | $0 | $192 | 0.85% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 EAST HAMILTON AVENUE SUITE 500 CAMPBELL, CA 95008 | EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | $225 | $0 | $225 | 1.43% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION | $536 | $54 | $590 | 5.35% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 1150 MORAGA WAY MORAGA, CA 94556 | SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION | $370 | $169 | $539 | 4.88% |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 351 | $3.7M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 543 | $440K |
| Vision(2 contracts, 2 carriers) | VISION SERVICE PLAN | 234 | $38K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 543 | $549K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 404 | $119K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 404 | $119K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 351 | $3.7M |
| Other(3 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 543 | $562K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 543 | — |
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.