| 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 | BLUE SHIELD OF CALIFORNIA | $11 | $218K | $218K | 4.81% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E. HAMILTON AVE, STE 500 CAMPBELL, CA 950080667 | KAISER FOUNDATION HEALTH PLAN INC | $52K | $3 | $52K | 4.54% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E. HAMILTON AVE, STE 500 CAMPBELL, CA 95008 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $27K | — | $27K | 9.99% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E. HAMILTON AVE, STE 500 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $7K | $7K | 5.47% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E. HAMILTON AVE, STE 500 CAMPBELL, CA 950080667 | KAISER FOUNDATION HEALTH PLAN INC | $4K | — | $4K | 4.91% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E. HAMILTON AVE, STE 500 CAMPBELL, CA 95008 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $7K | $0 | $7K | 10.03% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E. HAMILTON AVE, STE 500 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $17K | — | $17K | 25.00% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E. HAMILTON AVE, STE 500 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $4K | $4K | 5.11% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 900 E. HAMILTON AVE, STE 500 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | — | $5K | 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 | — | $3K | $3K | 5.43% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 1150 MORAGA WAY MORAGA, CA 945561113 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | — | $5K | 9.91% |
| CYNTHIA LUQUIN3 | 1615 WILSON AVENUE UPLAND, CA 91784 | CONTINENTAL AMERICAN INSURANCE COMPANY | $3K | — | $3K | 14.82% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE SERVICES, LLC | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | CONTINENTAL AMERICAN INSURANCE COMPANY | $2K | — | $2K | 11.28% |
| PATRICIA GAIL LEES3 Filed as: PATRICIA G LEES | 1124 CHURCHS CT BURBANK, CA 91501 | CONTINENTAL AMERICAN INSURANCE COMPANY | $164 | — | $164 | 0.81% |
| DAVID J REESOR3 | 1615 WILSON AVENUE UPLAND, CA 91784 | CONTINENTAL AMERICAN INSURANCE COMPANY | $61 | — | $61 | 0.30% |
| ARLICE C. MARSHALL3 Filed as: ARLICE C MARSHALL | 23709 BLACKBIRD CIRCLE MORENO VALLEY, CA 92557 | CONTINENTAL AMERICAN INSURANCE COMPANY | $59 | — | $59 | 0.29% |
| DALE C. VAN WAGNER3 Filed as: DALE C VAN WAGNER | 1456 E PHILADELPHIA ST SPC 170 ONTARIO, CA 91761 | CONTINENTAL AMERICAN INSURANCE COMPANY | $42 | — | $42 | 0.21% |
| FRANCOISE YVONNE KORENBERG3 Filed as: FRANCOISE Y KORENBERG | 156 N ORANGE DR LOS ANGELES, CA 90036 | CONTINENTAL AMERICAN INSURANCE COMPANY | $41 | — | $41 | 0.20% |
| DAVID J REESOR3 | 1615 WILSON AVENUE UPLAND, CA 91784 | CONTINENTAL AMERICAN INSURANCE COMPANY | $35 | — | $35 | 0.17% |
| CYNTHIA LUQUIN3 | 1615 WILSON AVENUE UPLAND, CA 91784 | CONTINENTAL AMERICAN INSURANCE COMPANY | $30 | — | $30 | 0.15% |
| SHEM J BOSTICK3 | 1620 DITMAR ST OCEANSIDE, CA 92054 | CONTINENTAL AMERICAN INSURANCE COMPANY | $11 | — | $11 | 0.05% |
| DAVID M COUGHLIN3 | 2229 WHITE MIST DRIVE LAS VEGAS, NV 89134 | CONTINENTAL AMERICAN INSURANCE COMPANY | $5 | — | $5 | 0.02% |
| 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 | 900 E. HAMILTON AVE, STE 500 CAMPBELL, CA 95008 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $657 | $657 | 5.70% |
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 | 380 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 385 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | BLUE SHIELD OF CALIFORNIA | 248 | $5.8M |
| Dental(2 contracts) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 322 | $343K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 830 | $51K |
| Life insurance(2 contracts, 2 carriers) | CONTINENTAL AMERICAN INSURANCE COMPANY | 387 | $32K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 382 | $125K |
| Prescription drug | BLUE SHIELD OF CALIFORNIA | 248 | $4.5M |
| Other(3 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 387 | $133K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 830 | — |
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.