| 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 | $29K | $1 | $29K | 3.65% |
| FILICE INSURANCE AGENCY3 | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | SUTTER HEALTH PLAN | $6K | — | $6K | 5.00% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 E HAMILTON AVE CAMPBELL, CA 95008 | DELTA DENTAL OF CALIFORNIA | $7K | — | $7K | 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 | $2K | $946 | $3K | 14.79% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 EAST HAMILTON AVENUE SUITE 500 CAMPBELL, CA 95008 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $1K | $378 | $2K | 12.56% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E. HAMILTON AVE CAMPBELL, CA 95008 | VISION SERVICE PLAN | $1K | — | $1K | 10.91% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 E HAMILTON AVE STE 500 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $532 | $2K | 19.77% |
| ACRISURE LLC3 | 900 E HAMILTON AVE CAMPBELL, CA 95008 | LANDMARK HEALTHPLAN | $572 | — | $572 | 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 | $178 | $82 | $260 | 14.61% |
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 | 105 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 108 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 100 | $923K |
| Dental | DELTA DENTAL OF CALIFORNIA | 125 | $71K |
| Vision | VISION SERVICE PLAN | 99 | $13K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 103 | $20K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 19 | $2K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 103 | $11K |
| Prescription drug | SUTTER HEALTH PLAN | 19 | $126K |
| Other(3 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 105 | $40K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 125 | — |
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.