| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PETRA PACIFIC INSURANCE SERVICE, IN3 Filed as: PETRA PACIFIC INS. SERVICE, INC. | 13950 CERRITOS CORPORATE DRIVE SUITE A CERRITOS, CA 90703 | KAISER FOUNDATION HEALTH PLAN, INC. | $43K | $0 | $43K | 5.00% |
| PETRA PACIFIC INSURANCE SERVICE, IN3 Filed as: PETRA PACIFIC INS. SERVICE, INC. | 770 THE CITY DRIVE SOUTH SUITE 1500 ORANGE, CA 92868 | UNITEDHEALTHCARE INSURANCE COMPANY | $12K | $0 | $12K | 4.46% |
| BEERE & PURVES INC3 Filed as: BEERE AND PURVES, INC. | 500 YGNACIO VALLEY ROAD, SUITE 450 WALNUT CREEK, CA 94596 | UNITEDHEALTHCARE INSURANCE COMPANY | $5K | $0 | $5K | 1.96% |
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE BROKERAGE, INC. | 333 WEST WACKER DRIVE, SUITE 1200 CHICAGO, IL 60606 | UNITEDHEALTHCARE INSURANCE COMPANY | $1K | $0 | $1K | 0.43% |
| PETRA PACIFIC INSURANCE SERVICE, IN3 Filed as: PETRA PACIFIC INS. SERVICE, INC. | 770 THE CITY DRIVE SOUTH SUITE 1500 ORANGE, CA 92868 | DELTA DENTAL OF CALIFORNIA | $10K | $0 | $10K | 9.20% |
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE BROKERAGE, INC. | 160 FEDERAL STREET, 4TH FLOOR BOSTON, MA 02110 | DELTA DENTAL OF CALIFORNIA | $891 | $0 | $891 | 0.80% |
| PETRA PACIFIC INSURANCE SERVICE, IN3 Filed as: PETRA PACIFIC INS. SERVICE, INC. | 770 THE CITY DRIVE SOUTH SUITE 1500 ORANGE, CA 92868 | SUN LIFE ASSURANCE COMPANY OF CANADA | $9K | $0 | $9K | 14.42% |
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE BROKERAGE, INC. | 160 FEDERAL STREET, 4TH FLOOR BOSTON, MA 02110 | SUN LIFE ASSURANCE COMPANY OF CANADA | $387 | $0 | $387 | 0.62% |
| PETRA PACIFIC INSURANCE SERVICE, IN3 Filed as: PETRA PACIFIC INS. SERVICE, INC. | 770 THE CITY DRIVE SOUTH SUITE 1500 ORANGE, CA 92868 | VISION SERVICE PLAN | $2K | $0 | $2K | 9.18% |
| RSC INSURANCE BROKERAGE INC3 Filed as: RSC INSURANCE BROKERAGE, INC. | 160 FEDERAL STREET, 4TH FLOOR BOSTON, MA 02110 | VISION SERVICE PLAN | $198 | $0 | $198 | 0.82% |
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 | 352 | 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) | 352 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 122 | $1.1M |
| Dental | DELTA DENTAL OF CALIFORNIA | 236 | $111K |
| Vision | VISION SERVICE PLAN | 133 | $24K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 352 | $62K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 352 | $62K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 122 | $1.1M |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 352 | $62K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 352 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.