| 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 | $145 | $234K | $234K | 5.28% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E. HAMILTON AVE, STE 500 CAMPBELL, CA 950080667 | KAISER FOUNDATION HEALTH PLAN INC | $43K | — | $43K | 4.50% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E. HAMILTON AVE, STE 500 CAMPBELL, CA 95008 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $12K | — | $12K | 5.00% |
| CASSIDY O'HARA3 Filed as: CASSIDY E. O'HARA | 738 N FIRST ST, #200 SAN JOSE, CA 95112 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $12K | — | $12K | 4.96% |
| CASSIDY O'HARA3 Filed as: CASSIDY EVAN O'HARA | 738 N 1ST ST SAN JOSE, CA 951126300 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $933 | $933 | 0.88% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E. HAMILTON AVE, STE 500 CAMPBELL, CA 950080667 | KAISER FOUNDATION HEALTH PLAN INC | $3K | — | $3K | 4.18% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E. HAMILTON AVE, STE 500 CAMPBELL, CA 950080667 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | — | $3K | 5.02% |
| CASSIDY O'HARA3 Filed as: CASSIDY E. O'HARA | 738 N 1ST ST SAN JOSE, CA 951126300 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | — | $2K | 3.51% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E. HAMILTON AVE, STE 500 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $9K | — | $9K | 17.31% |
| 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 | 7.69% |
| CASSIDY O'HARA3 Filed as: CASSIDY E. O'HARA | 738 N 1ST ST SAN JOSE, CA 95112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $536 | $536 | 0.99% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E. HAMILTON AVE, STE 500 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 6.83% |
| CASSIDY O'HARA3 Filed as: CASSIDY E. O'HARA | 738 N 1ST ST SAN JOSE, CA 95112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 3.17% |
| CASSIDY O'HARA3 Filed as: CASSIDY E. O'HARA | 738 N 1ST ST SAN JOSE, CA 95112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $375 | $375 | 0.86% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 738 NORTH FIRST STREET STE 202 SAN JOSE, CA 95112 | CONTINENTAL AMERICAN INSURANCE COMPANY | $599 | — | $599 | 2.58% |
| CYNTHIA LUQUIN3 | 2220 E ROUTE 66 SUITE 215 GLENDORA, CA 91740 | CONTINENTAL AMERICAN INSURANCE COMPANY | $355 | — | $355 | 1.53% |
| PATRICIA GAIL LEES3 Filed as: PATRICIA G LEES | 1124 CHURCHS CT BURBANK, CA 91501 | CONTINENTAL AMERICAN INSURANCE COMPANY | $331 | — | $331 | 1.42% |
| DAVID REESOR3 | 1615 WILSON AVENUE UPLAND, CA 91784 | CONTINENTAL AMERICAN INSURANCE COMPANY | $97 | — | $97 | 0.42% |
| FRANCOISE YVONNE KORENBERG3 Filed as: FRANCOISE Y KORENBERG | 6055 E WASHINGTON BLVD, SUITE 460 COMMERCE, CA 90040 | CONTINENTAL AMERICAN INSURANCE COMPANY | $96 | — | $96 | 0.41% |
| DAVID REESOR3 | 1615 WILSON AVENUE UPLAND, CA 91784 | CONTINENTAL AMERICAN INSURANCE COMPANY | $71 | — | $71 | 0.31% |
| SHEM J BOSTICK3 Filed as: SHEM J. BOSTICK | 1325 MT. HERMON RD #73B SALISBURY, MD 21804 | CONTINENTAL AMERICAN INSURANCE COMPANY | $29 | — | $29 | 0.12% |
| DALE C. VAN WAGNER3 Filed as: DALE C VAN WAGNER | PO BOX 278 CHINO, CA 91708 | CONTINENTAL AMERICAN INSURANCE COMPANY | $19 | — | $19 | 0.08% |
| DAVID M COUGHLIN3 | 2229 WHITE MIST DRIVE LAS VEGAS, NV 89134 | CONTINENTAL AMERICAN INSURANCE COMPANY | $15 | — | $15 | 0.06% |
| CYNTHIA LUQUIN3 | 2220 E ROUTE 66 SUITE 215 GLENDORA, CA 91740 | CONTINENTAL AMERICAN INSURANCE COMPANY | $8 | — | $8 | 0.03% |
| 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 | — | $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 | — | $541 | $541 | 5.31% |
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 | 292 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 296 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | BLUE SHIELD OF CALIFORNIA | 228 | $5.5M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 281 | $250K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 742 | $60K |
| Life insurance(2 contracts, 2 carriers) | CONTINENTAL AMERICAN INSURANCE COMPANY | 332 | $33K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 328 | $105K |
| Prescription drug | BLUE SHIELD OF CALIFORNIA | 228 | $4.4M |
| Other(3 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 332 | $108K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 742 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.