| 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 | $23K | — | $23K | 3.67% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS | 3155 OLSEN DR STE 400 SAN JOSE, CA 95117 | SUTTER HEALTH PLAN | $20K | — | $20K | 5.00% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 1150 MORAGA WAY MORAGA, CA 94556 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | — | $2K | 3.05% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST INS | SERVICES LLC 3155 OLSEN DR SAN JOSE, CA 95117 | METROPOLITAN LIFE INSURANCE COMPANY | $593 | $676 | $1K | 1.71% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $993 | $2K | 10.17% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | INSURANCE 3155 OLSEN DR, STE 400 SAN JOSE, CA 95117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $958 | — | $958 | 4.49% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 EAST HAMILTON AVE SUITE 500 CAMPBELL, CA 95008 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | $283 | $2K | 11.36% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | INSURANCE SERVICES LLC 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | VISION SERVICE PLAN | $1K | — | $1K | 9.21% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E. HAMILTON AVE CAMPBELL, CA 95008 | VISION SERVICE PLAN | $104 | — | $104 | 0.74% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $561 | $2K | 12.88% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | INSURANCE 3155 OLSEN DR, STE 400 SAN JOSE, CA 95117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $820 | — | $820 | 6.73% |
| NICOLE ROSENBAUM3 | 900 E HAMILTON AVE CAMPBELL, CA 95008 | LANDMARK HEALTHPLAN | $739 | — | $739 | 10.00% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $183 | $97 | $280 | 8.37% |
| ACRISURE LLC3 Filed as: ACRISURE PARTNERS WEST COAST | INSURANCE 3155 OLSEN DR, STE 400 SAN JOSE, CA 95117 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $152 | — | $152 | 4.54% |
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 | 124 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 126 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 79 | $1.0M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 168 | $74K |
| Vision | VISION SERVICE PLAN | 115 | $14K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 120 | $21K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 27 | $3K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 120 | $12K |
| Prescription drug | SUTTER HEALTH PLAN | 53 | $407K |
| Other(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 120 | $50K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 168 | — |
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.