| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 738 NORTH FIRST STREET SAN JOSE, CA 95112 | BLUE SHIELD OF CALIFORNIA | $130 | $234K | $234K | 5.27% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 738 N 1ST ST STE 202 SAN JOSE, CA 951126371 | KAISER FOUNDATION HEALTH PLAN INC | $36K | $438 | $37K | 5.91% |
| CASSIDY O'HARA3 Filed as: CASSIDY E. O'HARA | 738 N FIRST ST, #200 SAN JOSE, CA 95112 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $26K | — | $26K | 9.96% |
| CASSIDY O'HARA3 Filed as: CASSIDY EVAN O'HARA | 738 N 1ST ST SAN JOSE, CA 951126300 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $6K | $6K | 5.42% |
| CASSIDY O'HARA3 Filed as: CASSIDY E. O'HARA | 738 N 1ST ST SAN JOSE, CA 95112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $15K | — | $15K | 25.00% |
| CASSIDY O'HARA3 Filed as: CASSIDY E. O'HARA | 738 N 1ST ST SAN JOSE, CA 95112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $3K | $3K | 4.85% |
| CASSIDY O'HARA3 Filed as: CASSIDY E. O'HARA | 738 N 1ST ST SAN JOSE, CA 951126300 | METROPOLITAN LIFE INSURANCE COMPANY | $6K | — | $6K | 10.84% |
| CASSIDY O'HARA3 Filed as: CASSIDY E. O'HARA | 738 N 1ST ST SAN JOSE, CA 95112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 10.00% |
| CASSIDY O'HARA3 Filed as: CASSIDY E. O'HARA | 738 N 1ST ST SAN JOSE, CA 95112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 4.99% |
| FILICE INSURANCE AGENCY3 Filed as: RON FILICE ENTERPRISES, INC. | 738 NORTH FIRST STREET SAN JOSE, CA 95112 | CONTINENTAL AMERICAN INSURANCE COMPANY | $719 | — | $719 | 4.82% |
| CYNTHIA LUQUIN3 | 1615 WILSON AVENUE UPLAND, CA 91784 | CONTINENTAL AMERICAN INSURANCE COMPANY | $522 | — | $522 | 3.50% |
| PATRICIA GAIL LEES3 Filed as: PATRICIA G LEES | 1124 CHURCHS CT BURBANK, CA 91501 | CONTINENTAL AMERICAN INSURANCE COMPANY | $231 | — | $231 | 1.55% |
| DALE C. VAN WAGNER3 Filed as: DALE C VAN WAGNER | PO BOX 278 CHINO, CA 91708 | CONTINENTAL AMERICAN INSURANCE COMPANY | $75 | — | $75 | 0.50% |
| FRANCOISE YVONNE KORENBERG3 Filed as: FRANCOISE Y KORENBERG | 6055 E WASHINGTON BLVD, SUITE 460 COMMERCE, CA 90040 | CONTINENTAL AMERICAN INSURANCE COMPANY | $67 | — | $67 | 0.45% |
| DAVID REESOR3 | 1615 WILSON AVENUE UPLAND, CA 91784 | CONTINENTAL AMERICAN INSURANCE COMPANY | $66 | — | $66 | 0.44% |
| DAVID REESOR3 | 1615 WILSON AVENUE UPLAND, CA 91784 | CONTINENTAL AMERICAN INSURANCE COMPANY | $62 | — | $62 | 0.42% |
| SHEM J BOSTICK3 Filed as: SHEM J. BOSTICK | 1325 MT. HERMON RD #73B SALISBURY, MD 21804 | CONTINENTAL AMERICAN INSURANCE COMPANY | $34 | — | $34 | 0.23% |
| DAVID M COUGHLIN3 | 2229 WHITE MIST DRIVE LAS VEGAS, NV 89134 | CONTINENTAL AMERICAN INSURANCE COMPANY | $23 | — | $23 | 0.15% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 738 N 1ST ST SAN JOSE, CA 95112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 10.00% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 738 N 1ST ST SAN JOSE, CA 95112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $593 | $593 | 5.53% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 738 N 1ST ST SAN JOSE, CA 951126371 | KAISER FOUNDATION HEALTH PLAN INC | $558 | $3 | $561 | 8.25% |
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 | 352 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 357 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | BLUE SHIELD OF CALIFORNIA | 257 | $5.1M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 269 | $261K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 726 | $53K |
| Life insurance(2 contracts, 2 carriers) | CONTINENTAL AMERICAN INSURANCE COMPANY | 319 | $26K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 317 | $102K |
| Prescription drug | BLUE SHIELD OF CALIFORNIA | 257 | $4.4M |
| Other(3 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 319 | $110K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 726 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.