| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JOSEPH DOMINE3 | 257 N 1ST ST SAN JOSE, CA 951131014 | KAISER FOUNDATION HEALTH PLAN INC | $19K | — | $19K | 4.95% |
| AMWINS3 Filed as: LISI, INC (GA) | 1600 W HILLSDALE BLVD STE 201 SAN MATEO, CA 944023766 | KAISER FOUNDATION HEALTH PLAN INC | $7K | — | $7K | 1.98% |
| JOSEPH DOMINE3 Filed as: JOSEPH ERNEST DOMINE | 257 N 1ST ST SAN JOSE, CA 951131014 | UNITEDHEALTHCARE INSURANCE COMPANY | $5K | — | $5K | 5.44% |
| AMWINS3 Filed as: LISI LLC | 1600 W HILLSDALE BLVD STE 201 SAN MATEO, CA 944023766 | UNITEDHEALTHCARE INSURANCE COMPANY | $2K | — | $2K | 2.17% |
| JOE DOMINE3 | 257 NORTH 1ST STREET SAN JOSE, CA 95113 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | $5K | — | $5K | 9.87% |
| AMWINS3 Filed as: LISI LLC | 1600 W HILLSDALE BLVD. SUITE #201 SAN MATEO, CA 94402 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | — | $2K | $2K | 3.95% |
| JOSEPH DOMINE3 | 257 NORTH 1ST STREET SAN JOSE, CA 95113 | LANDMARK HEALTHPLAN | $529 | — | $529 | 9.99% |
| JOSEPH DOMINE3 Filed as: JOSEPH ERNEST DOMINE | 257 NORTH 1ST ST SAN JOSE, CA 95113 | MANAGED HEALTH NETWORK | $108 | — | $108 | 5.00% |
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 | 159 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 159 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 62 | $468K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 74 | $47K |
| Other(2 contracts, 2 carriers) | LANDMARK HEALTHPLAN | 87 | $7K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 87 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.