| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DOMINE, JOSEPH3 | 257 NORTH 1ST STREET SAN JOSE, CA 95113 | BLUE CROSS OF CALIFORNIA | $164K | — | $164K | 42.91% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE | SERVICES LLC 2677 N MAIN STREET, STE 800 SANTA ANA, CA 92705 | BLUE CROSS OF CALIFORNIA | — | $62K | $62K | 16.20% |
| JOSEPH DOMINE3 | 257 N 1ST ST SAN JOSE, CA 951131014 | KAISER FOUNDATION HEALTH PLAN, INC. | $16K | — | $16K | 4.98% |
| JOSEPH DOMINE3 | 257 NORTH 1ST STREET SAN JOSE, CA 95113 | DELTA | $25K | — | $25K | 10.00% |
| JOSEPH DOMINE3 | 257 N 1ST ST SAN JOSE, CA 951131014 | KAISER FOUNDATION HEALTH PLAN, INC. | $11K | — | $11K | 4.70% |
| JOSEPH DOMINE3 | 257 NORTH 1ST STREET SAN JOSE, CA 95113 | ANTHEM LIFE INSURANCE COMPANY | $15K | — | $15K | 17.68% |
| AMWINS3 Filed as: AMWINS CONNECT INS SVCS LLC | 2677 N MAIN ST STE 800 SANTA ANA, CA 92705 | ANTHEM LIFE INSURANCE COMPANY | $853 | $153 | $1K | 1.18% |
| JOSEPH DOMINE3 | 257 NORTH 1ST STREET SAN JOSE, CA 95113 | ANTHEM LIFE INSURANCE COMPANY | $12K | — | $12K | 17.66% |
| AMWINS3 Filed as: AMWINS CONNECT INS SVCS LLC | 2677 N. MAIN ST STE 800 SANTA ANA, CA 92705 | ANTHEM LIFE INSURANCE COMPANY | $677 | $120 | $797 | 1.18% |
| JOE DOMINE3 | 257 N 1ST ST SAN JOSE, CA 951131014 | VISION SERVICE PLAN | $2K | — | $2K | 5.02% |
| ENROLLEASE3 Filed as: ENROLLEASE, INC DBA | EASECENTRAL 1980 FESTIVAL PLAZA DR STE 810 LAS VEGAS, NV 891352958 | VISION SERVICE PLAN | $49 | — | $49 | 0.11% |
| ESTRADA ENTERPRISES LLC3 Filed as: ESTRADA ENTREPRISES LLC | 5340 EDGEVIEW DR DISCOVERY BAY, CA 94505 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 3.73% |
| JOSEPH DOMINE3 Filed as: JOSEPH ERNEST DOMINE | 257 N 1ST ST SAN JOSE, CA 95113 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $778 | — | $778 | 2.45% |
| THOMAS MARTIN LEVINSTEIN3 | 16 PHEASANT LANE ALISO VIEJO, CA 92656 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $478 | — | $478 | 1.51% |
| MARK TETSUO IWASAKI3 | 133 CRABAPPLE CT HERCULES, CA 94547 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $446 | — | $446 | 1.41% |
| JAN HEJRET3 | 644 N 17TH ST SAN JOSE, CA 95112 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $39 | $104 | $143 | 0.45% |
| CATHERINE LISA LUKE3 | 9351 OAK VIEW DR OAKDALE, CA 95361 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $91 | — | $91 | 0.29% |
| MARK JOHN KANITRA3 | 1009 S RISING SUN CT ANAHEIM, CA 92808 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $36 | — | $36 | 0.11% |
| BRUCE NAM NGUYEN3 | 207 PEPPERMINT TREE TER UNIT 9 SUNNYVALE, CA 94086 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.01% |
| JOSEPH DOMINE3 | 257 NORTH 1ST STREET SAN JOSE, CA 95113 | ANTHEM LIFE INSURANCE COMPANY | $5K | — | $5K | 17.65% |
| AMWINS3 Filed as: AMWINS CONNECT INS SVCS LLC | 2677 N MAIN ST STE 800 SANTA ANA, CA 92705 | ANTHEM LIFE INSURANCE COMPANY | $260 | $46 | $306 | 1.18% |
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 | 203 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 210 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 329 | $954K |
| Dental(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 329 | $633K |
| Vision(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 329 | $426K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 250 | $85K |
| Short-term disability(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 203 | $58K |
| Long-term disability | ANTHEM LIFE INSURANCE COMPANY | 203 | $68K |
| Other(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 329 | $499K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 329 | — |
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.