| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INTERWEST INSURANCE SERVICES, LLC3 Filed as: INTERWEST INSURANCE SERVICES | 3636 AMERICAN RIVER DRIVE 2ND FLOOR SACRAMENTO, CA 95864 | CALIFORNIA PHYSICIANS SERVICES | $38K | — | $38K | 4.00% |
| INTERWEST INSURANCE SERVICES, LLC3 Filed as: INTERWEST INSURANCE SERVICES, INC. | PO BOX 255188 SACRAMENTO, CA 95865 | KAISER FOUNDATION HEALTH PLAN, INC. | $20K | — | $20K | 2.80% |
| INTERWEST INSURANCE SERVICES, LLC3 Filed as: INTERWEST INSURANCE SERVICES | PO BOX 255188 SACRAMENTO, CA 95865 | STANDARD INSURANCE COMPANY | $8K | $2K | $10K | 4.13% |
| JAMES A. BULOTTI3 | 3636 AMERICAN RIVER DRIVE 2ND FLOOR SACRAMENTO, CA 95864 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 2.92% |
| JAMES A. BULOTTI3 | PO BOX 255188 SACRAMENTO, CA 95865 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 15.00% |
| INTERWEST INSURANCE SERVICES, LLC3 Filed as: INTERWEST INSURANCE SERVICES | 330 TES PINOS ROAD, SUITE A1 HOLLISTER, CA 95023 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $105 | $105 | 1.25% |
| INTERWEST INSURANCE SERVICES, LLC3 Filed as: INTERWEST INSURANCE SERVICES | 3636 AMERICAN RIVER DRIVE 2ND FLOOR SACRAMENTO, CA 95864 | BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH INSURANCE COMPANY | $95 | — | $95 | 3.99% |
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 | 152 | 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) | 152 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICES | 141 | $1.7M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 135 | $141K |
| Life insurance(2 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 152 | $251K |
| Long-term disability | STANDARD INSURANCE COMPANY | 152 | $248K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICES | 141 | $1.7M |
| Other(3 contracts, 3 carriers) | STANDARD INSURANCE COMPANY | 152 | $259K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 152 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.