Form 5500 · Employee benefit plan · SACRAMENTO, CA
TILESETTERS AND IFINISHERS OF NO CA HEALTH AND WELFARE PLAN
The filing calls this plan TILE SETTERS AND FINISHERS OF NO CA HEALTH & WELFARE.
Public Form 5500 records show how TILESETTERS AND IFINISHERS OF NO CA HEALTH AND WELFARE PLAN of SACRAMENTO, CA, a other services employer, structures its employee benefits. Its broker of record is USI INSURANCE SERVICES LLC. Coverage is written through KAISER FOUNDATION HEALTH PLAN, INC. and 4 other carriers. The plan's most recent policy period ended in September.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 68-0482902 · plan 501 · plan year 2024, filed May 15, 2025
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How this plan is funded
Fully insured as reported
The plan's own financial statement reports paying insurance carriers about what the insurance contracts report in premium.
Benefits declared on this filing
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 5 insured contracts covering health, dental, vision and life; the largest, with KAISER FOUNDATION HEALTH PLAN, INC., covers 127 people.
Reported premium across the insured contracts is $1,385,988, with $57,090 in disclosed broker commissions — about 4.1% of premium.
The most recent policy period ended in September, and the plan year ends July 31. Group contracts typically renew on that annual cycle.
USI INSURANCE SERVICES LLC is the broker of record on all 5 contracts.
5 carriers appear on the filing, including KAISER FOUNDATION HEALTH PLAN, INC., WESTERN HEALTH ADVANTAGE, CYPRESS DENTAL ADMINISTRATORS and VISION SERVICE PLAN. KAISER FOUNDATION HEALTH PLAN, INC. writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| KAISER FOUNDATION HEALTH PLAN, INC. | Health | 127 | Oct 1, 2024 | $834,215 | $31,739 |
| WESTERN HEALTH ADVANTAGE | Health | 69 | Oct 1, 2024 | $453,440 | $20,010 |
| CYPRESS DENTAL ADMINISTRATORS | Health, Dental | 77 | Oct 1, 2024 | $79,824 | $3,869 |
| VISION SERVICE PLAN | Health, Vision | 80 | Oct 1, 2024 | $14,127 | $886 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | Life | 97 | Oct 1, 2024 | $4,382 | $586 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. The service providers are named on Schedule C of this filing. We publish company names only.
Money the plan held and paid out
Sourced from U.S. DOL EFAST2 Form 5500 · Schedule H
These are the plan's own figures from Schedule H, the financial statement it files. They are not the premium on Schedule A.
How this plan compares
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