| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 EAST HAMILTON AVENUE, SUITE 500 CAMPBELL, CA 95008 | KAISER FOUNDATION HEALTH PLAN, INC. | $19K | $0 | $19K | 2.72% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN, INC. | $4K | $0 | $4K | 0.51% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 1950 WEST CORPORATE WAY SUITE 33276 ANAHEIM, CA 92801 | UNITEDHEALTHCARE INSURANCE COMPANY | $9K | $0 | $9K | 1.39% |
| ACRISURE LLC3 Filed as: ACRISURE PRTNRS WEST COAST INS SVCS | 1950 WEST CORPORATE WAY SUITE 33276 ANAHEIM, CA 92801 | UNITEDHEALTHCARE INSURANCE COMPANY | $7K | $0 | $7K | 0.96% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES LLC | 900 EAST HAMILTON AVENUE, SUITE 500 CAMPBELL, CA 95008 | UNITEDHEALTHCARE INSURANCE COMPANY | $4K | $0 | $4K | 0.63% |
| USI INSURANCE SERVICES LLC3 | 575 MARKET STREET, SUITE 3750 SAN FRANCISCO, CA 94105 | UNITEDHEALTHCARE INSURANCE COMPANY | $4K | $0 | $4K | 0.58% |
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 | 103 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 104 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 200 | $1.4M |
| Dental | UNITEDHEALTHCARE INSURANCE COMPANY | 200 | $681K |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 200 | $681K |
| Life insurance | UNITEDHEALTHCARE INSURANCE COMPANY | 200 | $681K |
| Long-term disability | UNITEDHEALTHCARE INSURANCE COMPANY | 200 | $681K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 200 | $1.4M |
| Other | UNITEDHEALTHCARE INSURANCE COMPANY | 200 | $681K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 200 | — |
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.