| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PETRA PACIFIC INSURANCE SERVICE, IN3 | 13950 CERRITOS CORPORATE DRIVE SUITE A CERRITOS, CA 90703 | KAISER FOUNDATION HEALTH PLAN, INC. | $30K | — | $30K | 5.40% |
| PETRA PACIFIC INSURANCE SERVICE INC3 | 770 THE CITY DRIVE SOUTH SUITE 1500 ORANGE, CA 92868 | UNITEDHEALTHCARE INSURANCE COMPANY | $7K | — | $7K | 4.90% |
| PETRA PACIFIC INSURANCE SERVICE INC3 | — | DELTA DENTAL OF CALIFORNIA | $5K | — | $5K | 10.00% |
| PETRA PACIFIC INSURANCE SERVICE, IN3 Filed as: PETRA PACIFIC INSURANCE SERIVCE, IN | 13950 CERRITOS CORPORATE DRIVE SUITE A CERRITOS, CA 90703 | KAISER FOUNDATION HEALTH PLAN, INC. | $1K | — | $1K | 5.00% |
| PETRA PACIFIC INSURANCE SERVICE, IN3 | 770 THE CITY DRIVE SOUTH SUITE 1500 ORANGE, CA 92868 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 9.91% |
| PETRA PACIFIC INSURANCE SERVICE, IN3 | 770 THE CITY DRIVE SOUTH SUITE 1500 ORANGE, CA 92868 | VISION SERVICE PLAN | $1K | — | $1K | 10.04% |
| PETRA PACIFIC INSURANCE SERVICE, IN3 | 770 THE CITY DRIVE SOUTH SUITE 1500 ORANGE, CA 92868 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $848 | — | $848 | 9.91% |
| PETRA PACIFIC INSURANCE SERVICE INC3 | — | DELTA DENTAL OF CALIFORNIA | $356 | — | $356 | 9.92% |
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 | 226 | 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) | 226 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 83 | $707K |
| Dental(2 contracts) | DELTA DENTAL OF CALIFORNIA | 68 | $52K |
| Vision | VISION SERVICE PLAN | 72 | $13K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 305 | $25K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 305 | $25K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 305 | — |
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.