| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DOMINE, JOSEPH3 | 257 NORTH 1ST STREET SAN JOSE, CA 95113 | BLUE CROSS OF CALIFORNIA | $177K | — | $177K | 5.67% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE | SERVICES LLC 2677 N. MAIN STREET, STE. 800 SANTA ANA, CA 92705 | BLUE CROSS OF CALIFORNIA | — | $20K | $20K | 0.64% |
| JOSEPH DOMINE3 | 257 NORTH 1ST STREET SAN JOSE, CA 95113 | DELTA | $31K | — | $31K | 10.00% |
| JOSEPH DOMINE3 | 257 N 1ST ST SAN JOSE, CA 951131014 | KAISER FOUNDATION HEALTH PLAN INC | $15K | — | $15K | 4.97% |
| JOSEPH DOMINE3 | 257 N 1ST ST SAN JOSE, CA 951131014 | KAISER FOUNDATION HEALTH PLAN INC | $13K | — | $13K | 5.06% |
| DOMINE, JOSEPH3 | 257 NORTH 1ST STREET SAN JOSE, CA 95113 | STANDARD INSURANCE COMPANY | $21K | — | $21K | 13.61% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | LLC 2677 N. MAIN STREET, STE 800 SANTA ANA, CA 92705 | STANDARD INSURANCE COMPANY | — | $1K | $1K | 0.91% |
| ESTRADA ENTERPRISES LLC3 Filed as: ESTRADA ENTREPRISES LLC | 5340 EDGEVIEW DR DISCOVERY BAY, CA 94505 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $13 | $2K | 5.11% |
| JOSEPH DOMINE3 Filed as: JOSEPH ERNEST DOMINE | 257 N 1ST ST SAN JOSE, CA 95113 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | — | $2K | 3.52% |
| MARK TETSUO IWASAKI3 | 133 CRABAPPLE CT HERCULES, CA 94547 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $647 | — | $647 | 1.43% |
| THOMAS MARTIN LEVINSTEIN3 | 16 PHEASANT LANE ALISO VIEJO, CA 92656 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $323 | — | $323 | 0.71% |
| CATHERINE LISA LUKE3 | 9351 OAK VIEW DR OAKDALE, CA 95361 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $154 | — | $154 | 0.34% |
| BRUCE NAM NGUYEN3 | 207 PEPPERMINT TREE TER UNIT 9 SUNNYVALE, CA 94086 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $129 | $2 | $131 | 0.29% |
| JAN HEJRET3 | 644 N 17TH ST SAN JOSE, CA 95112 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $24 | $45 | $69 | 0.15% |
| MARK JOHN KANITRA3 | 1009 S RISING SUN CT ANAHEIM, CA 92808 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $18 | — | $18 | 0.04% |
| NICHOLAS RYAN DERRICO3 | 1745 W ORANGEWOOD AVE STE 212 ORANGE, CA 92868 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | $7 | $12 | 0.03% |
| MARIANNA REBECCA WEAVER3 | 20092 CHAMPLAIN LAKE FOREST, CA 92630 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | $3 | $8 | 0.02% |
| DEAN LOUIS GRANT3 | 1874 DREW AVE MOUNTAIN VIEW, CA 94043 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4 | — | $4 | 0.01% |
| JOE DOMINE3 | 257 N 1ST ST SAN JOSE, CA 951131014 | VISION SERVICE PLAN | $2K | — | $2K | 5.00% |
| ENROLLEASE3 Filed as: ENROLLEASE, INC DBA | EASECENTRAL 1980 FESTIVAL PLAZA DR STE 810 LAS VEGAS, NV 891352958 | VISION SERVICE PLAN | $547 | — | $547 | 1.25% |
| DOMINE, JOSEPH3 | 257 NORTH 1ST STREET SAN JOSE, CA 95113 | ANTHEM LIFE INSURANCE COMPANY | $3K | — | $3K | 7.63% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | LLC 2677 N. MAIN STREET, STE. 800 SANTA ANA, CA 92705 | ANTHEM LIFE INSURANCE COMPANY | — | $184 | $184 | 0.51% |
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 | 216 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 224 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 340 | $3.7M |
| Dental | DELTA | 189 | $309K |
| Vision | VISION SERVICE PLAN | 197 | $44K |
| Life insurance(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 340 | $3.3M |
| Short-term disability(4 contracts, 4 carriers) | BLUE CROSS OF CALIFORNIA | 340 | $3.4M |
| Long-term disability(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 340 | $3.3M |
| Other(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 340 | $3.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 340 | — |
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.