| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVE #200 WALNUT CREEK, CA 94596 | HEALTH NET | $186K | — | $186K | 7.06% |
| KEVIN SALTZMAN3 | 3924 W. CALDWELL AVE SUITE B VISALIA, CA 93277 | HEALTH NET | $13K | — | $13K | 0.48% |
| FILICE INSURANCE AGENCY3 Filed as: FELICE INSURANCE | 738 NORTH FIRST STREET SAN JOSE, CA 95112 | HEALTH NET | $774 | — | $774 | 0.03% |
| KEVIN SALTZMAN3 | 3924 W. CALDWELL AVE SUITE B VISALIA, CA 93277 | HEALTH NET | $10K | — | $10K | 0.93% |
| FILICE INSURANCE AGENCY3 Filed as: FELICE INSURANCE | 738 NORTH FIRST STREET SAN JOSE, CA 95112 | HEALTH NET | $532 | — | $532 | 0.05% |
| FILICE INSURANCE AGENCY3 Filed as: FELICE INSURANCE | 738 NORTH FIRST STREET SAN JOSE, CA 95112 | HEALTH NET | $2K | — | $2K | 0.36% |
| KEVIN SALTZMAN3 | 3924 W. CALDWELL AVE SUITE B VISALIA, CA 93277 | HEALTH NET | $1K | — | $1K | 0.25% |
| FILICE INSURANCE AGENCY3 Filed as: FELICE INSURANCE | 738 NORTH FIRST STREET SAN JOSE, CA 95112 | HEALTH NET | $2K | — | $2K | 1.18% |
| DC & ASSOCIATES3 | 1550 SAN SIERRA CT. WATSONVILLE, CA 95076 | HEALTH NET | $383 | — | $383 | 0.21% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVE #200 WALNUT CREEK, CA 94596 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | — | $6K | 4.20% |
| FILICE INSURANCE AGENCY3 Filed as: FELICE INSURANCE | 738 NORTH FIRST STREET SAN JOSE, CA 95112 | HEALTH NET | $1K | — | $1K | 1.18% |
| DC & ASSOCIATES3 | 1550 SAN SIERRA CT. WATSONVILLE, CA 95076 | HEALTH NET | $236 | — | $236 | 0.21% |
| FILICE INSURANCE AGENCY3 Filed as: FELICE INSURANCE | 738 NORTH FIRST STREET SAN JOSE, CA 95112 | HEALTH NET | $1K | — | $1K | 1.18% |
| DC & ASSOCIATES3 | 1550 SAN SIERRA CT. WATSONVILLE, CA 95076 | HEALTH NET | $203 | — | $203 | 0.21% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVE #200 WALNUT CREEK, CA 94596 | UNITED CONCORDIA INSURANCE COMPANY | $3K | — | $3K | 3.99% |
| FILICE INSURANCE AGENCY3 Filed as: FELICE INSURANCE | 738 NORTH FIRST STREET SAN JOSE, CA 95112 | UNITED CONCORDIA INSURANCE COMPANY | $984 | — | $984 | 1.27% |
| BARLOCKER INSURANCE AGENCY INC3 Filed as: BARLOCKER INSURANCE SERVICES | 371 MAIN STREET SALINAS, CA 93901 | UNITED CONCORDIA INSURANCE COMPANY | $231 | — | $231 | 0.30% |
| KEVIN SALTZMAN3 | 3924 W. CALDWELL AVE SUITE B VISALIA, CA 93277 | UNITED CONCORDIA INSURANCE COMPANY | $189 | — | $189 | 0.24% |
| DC & ASSOCIATES3 | 1550 SAN SIERRA CT. WATSONVILLE, CA 95076 | UNITED CONCORDIA INSURANCE COMPANY | $166 | — | $166 | 0.21% |
| FILICE INSURANCE AGENCY3 Filed as: FELICE INSURANCE | 738 NORTH FIRST STREET SAN JOSE, CA 95112 | HEALTH NET | $2K | — | $2K | 4.58% |
| DC & ASSOCIATES3 | 1550 SAN SIERRA CT. WATSONVILLE, CA 95076 | HEALTH NET | $667 | — | $667 | 1.42% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVE #200 WALNUT CREEK, CA 94596 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 5.22% |
| FILICE INSURANCE AGENCY3 Filed as: FELICE INSURANCE | 738 NORTH FIRST STREET SAN JOSE, CA 95112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $83 | — | $83 | 0.27% |
| KEVIN SALTZMAN3 | 3924 W. CALDWELL AVE SUITE B VISALIA, CA 93277 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $24 | — | $24 | 0.08% |
| DC & ASSOCIATES3 | 1550 SAN SIERRA CT. WATSONVILLE, CA 95076 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $16 | — | $16 | 0.05% |
| HEFFERNAN INSURANCE BROKERS3 | 1350 CARLBACK AVE #200 WALNUT CREEK, CA 94596 | VISION SERVICE PLAN | $1K | — | $1K | 4.50% |
| KEVIN SALTZMAN3 | 3924 W. CALDWELL AVE SUITE B VISALIA, CA 93277 | VISION SERVICE PLAN | $84 | — | $84 | 0.27% |
| FILICE INSURANCE AGENCY3 Filed as: FELICE INSURANCE | 738 NORTH FIRST STREET SAN JOSE, CA 95112 | VISION SERVICE PLAN | $53 | — | $53 | 0.17% |
| BARLOCKER INSURANCE AGENCY INC3 Filed as: BARLOCKER INSURANCE SERVICES | 371 MAIN STREET SALINAS, CA 93901 | VISION SERVICE PLAN | $9 | — | $9 | 0.03% |
| DC & ASSOCIATES3 | 1550 SAN SIERRA CT. WATSONVILLE, CA 95076 | VISION SERVICE PLAN | $9 | — | $9 | 0.03% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| WOLDS LAW GROUP EIN 80-0462356 NONE | Legal Service code 29 | 4747 EXECUTIVE DRIVE SUITE 250 SAN DIEGO, CA 92121 | $118K |
| ASSOCIATED BUILDERS AND CONTRACTORS EIN 92-2331973 SPONSOR ORGANIZATION | Contract Administrator Service code 13 | 4577 LAS POSITAS RD. UNIT C LIVERMORE, CA 94551 | $115K |
| UNITED ADMINISTRATIVE SERVICES EIN 94-1749354 NONE | Plan Administrator Service code 14 | 6800 SANTA TERESA BLVD, STE 100 SAN JOSE, CA 95119 | $69K |
| GALLINA LLP EIN 94-2147510 NONE | Accounting (including auditing) Service code 10 | 2999 OAK ROAD, SUITE 700 WALNUT CREEK, CA 94597 | $45K |
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 | 497 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 498 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(9 contracts, 3 carriers) | HEALTH NET | 238 | $4.8M |
| Dental(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 262 | $209K |
| Vision | VISION SERVICE PLAN | 424 | $31K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 449 | $31K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 449 | $31K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 449 | — |
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."
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.