| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JAMES A. BULOTTI3 Filed as: JAMES A BULOTTI | PO BOX 255188 SACRAMENTO, CA 95865 | UNUM LIFE INSURANCE CO OF AMERICA | $5K | — | $5K | 3.52% |
| INTERWEST INSURANCE SERVICES, LLC3 Filed as: INTERWEST INSURANCE SERVICES | 330 TRES PINOS RD STE A1 HOLLISTER, CA 95023 | UNUM LIFE INSURANCE CO OF AMERICA | $2K | $2K | $4K | 2.94% |
| INTERWEST INSURANCE SERVICES, LLC3 Filed as: INTERWEST INSURANCE SERVICES | 330 TRES PINOS RD STE A1 HOLLISTER, CA 95023 | UNUM LIFE INSURANCE CO OF AMERICA | $20K | $2K | $22K | 16.25% |
| INTERWEST INSURANCE SERVICES, LLC3 Filed as: INTERWEST INSURANCE SERVICES | 3636 AMERICAN RIVER DR SUITE 2 SACRAMENTO, CA 95864 | HUMANADENTAL INSURANCE COMPANY | $2K | $89 | $3K | 7.92% |
| INTERWEST INSURANCE SERVICES, LLC3 Filed as: INTERWEST INSURANCE SERVICES, INC. | 330 TRES PINOS RD STE A1 HOLLISTER, CA 95023 | CIGNA HEALTH AND LIFE INS CO | $1K | — | $1K | 9.14% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTHCOMP ADMINISTRATORS EIN 77-0385729 CONTRACT ADMIN | Claims processing; Direct payment from the plan; Contract Administrator Service code 12 | — | $257K |
| BLUE CROSS EIN 95-4331852 PPO/UR VENDOR | Direct payment from the plan; Other fees Service code 50 | — | $201K |
| INTERWEST BULOTTI & ASSOC EIN 68-0266090 BROKER | Direct payment from the plan; Insurance agents and brokers Service code 22 | — | $92K |
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 | 562 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 568 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(2 contracts, 2 carriers) | HUMANADENTAL INSURANCE COMPANY | 568 | $46K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE CO OF AMERICA | 604 | $285K |
| Long-term disability | UNUM LIFE INSURANCE CO OF AMERICA | 604 | $151K |
| Stop-loss / reinsurancereinsurance | BERKLEY LIFE AND HEALTH INSURANCE COMPANY | 572 | $779K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 604 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.