| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JOSEPH DOMINE3 Filed as: JOSEPH E DOMINE | 257 NORTH 1ST STREET SAN JOSE, CA 95113 | BLUE CROSS OF CALIFORNIA | $34K | — | $34K | 3.27% |
| DOMINE, JOSEPH3 | 1886 THE ALAMEDA SAN JOSE, CA 95126 | BLUE CROSS OF CALIFORNIA | $13K | — | $13K | 1.22% |
| AMWINS3 Filed as: LISI INC | 1600 W HILLSDALE BLVD SUITE 201 SAN MATEO, CA 94403 | BLUE CROSS OF CALIFORNIA | — | $4K | $4K | 0.38% |
| AMWINS3 Filed as: LISI INC | 1600 WEST HILLSDALE BLVD SAN MATEO, CA 94402 | BLUE CROSS OF CALIFORNIA | — | $1K | $1K | 0.10% |
| JOSEPH DOMINE3 | 257 N 1ST ST SAN JOSE, CA 951131014 | KAISER FOUNDATION HEALTH PLAN INC | $17K | — | $17K | 4.62% |
| JOSEPH DOMINE3 | 257 NORTH 1ST STREET SAN JOSE, CA 95113 | DELTA | $13K | — | $13K | 10.00% |
| JOSEPH DOMINE3 Filed as: JOSEPH E DOMINE | 257 NORTH 1ST STREET SAN JOSE, CA 95113 | STANDARD INSURANCE COMPANY | $4K | — | $4K | 11.27% |
| JOSEPH DOMINE3 Filed as: JOSEPH E DOMINE | 257 NORTH 1ST STREET SAN JOSE, CA 95113 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 7.01% |
| JOE DOMINE3 | 257 N 1ST ST SAN JOSE, CA 951131014 | VISION SERVICE PLAN | $1K | — | $1K | 5.44% |
| JOSEPH DOMINE3 Filed as: JOSEPH E DOMINE | 257 NORTH 1ST STREET SAN JOSE, CA 95113 | STANDARD INSURANCE COMPANY | $1K | — | $1K | 9.48% |
| CHRISTINA MARIE ALTOMARE3 | 1692 CRESCENT DRIVE WALNUT CREEK, CA 94598 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $463 | — | $463 | 8.18% |
| G SCOTT COOKE3 Filed as: SCOTT ALLEN BEER | 8385 N RAISINA AVE FRESNO, CA 93720 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $18 | — | $18 | 0.32% |
| KEVIN LEE SURLES SR3 | 376 SAN DIEGO AVE DALY CITY, CA 94014 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.18% |
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 | 110 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 111 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 165 | $1.4M |
| Dental | DELTA | 90 | $133K |
| Vision | VISION SERVICE PLAN | 103 | $21K |
| Life insurance | STANDARD INSURANCE COMPANY | 110 | $34K |
| Short-term disability | STANDARD INSURANCE COMPANY | 110 | $14K |
| Long-term disability | STANDARD INSURANCE COMPANY | 110 | $37K |
| Other | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 3 | $6K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 165 | — |
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.