| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GEORGE PETERSEN INSURANCE AGENCYINC3 | 175 WEST COLLEGE AVE SANTA ROSA, CA 65401 | BLUE CROSS OF CALIFORNIA | $26K | — | $26K | 4.55% |
| GEORGE PETERSEN INSURANCE AGENCYINC3 | 175 WEST COLLEGE AVE SANTA ROSA, CA 65401 | STARMOUNT LIFE INSURANCE COMPANY | $13K | $943 | $14K | 12.88% |
| GEORGE PETERSEN INSURANCE AGENCYINC3 | 175 WEST COLLEGE AVE SANTA ROSA, CA 65401 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $421 | $6K | 12.75% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 5114 POINT FOSDICK DR STE F41 GIG HARBOR, WA 98335 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $2 | $3K | 5.81% |
| GEORGE PETERSEN INSURANCE AGENCYINC3 | 175 WEST COLLEGE AVE SANTA ROSA, CA 65401 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | $411 | $7K | 14.17% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 5114 POINT FOSDICK DR STE F41 GIG HARBOR, WA 98335 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 5.96% |
| GEORGE PETERSEN INSURANCE AGENCYINC3 | 175 WEST COLLEGE AVE SANTA ROSA, CA 65401 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $236 | $4K | 15.22% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 5114 POINT FOSDICK DR STE F41 GIG HARBOR, WA 98335 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 5.93% |
| GEORGE PETERSEN INSURANCE AGENCYINC3 | 175 WEST COLLEGE AVE SANTA ROSA, CA 65401 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $66 | $1K | 18.19% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 5114 POINT FOSDICK DR STE F41 GIG HARBOR, WA 98335 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $443 | — | $443 | 5.78% |
| GEORGE PETERSEN INSURANCE AGENCYINC3 | 175 WEST COLLEGE AVE SANTA ROSA, CA 65401 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $663 | $33 | $696 | 15.40% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 5114 POINT FOSDICK DR STE F41 GIG HARBOR, WA 98335 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $221 | — | $221 | 4.89% |
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 | 84 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 89 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 79 | $572K |
| Dental(2 contracts, 2 carriers) | STARMOUNT LIFE INSURANCE COMPANY | 62 | $155K |
| Vision(2 contracts, 2 carriers) | STARMOUNT LIFE INSURANCE COMPANY | 62 | $155K |
| Life insurance(4 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 68 | $85K |
| Short-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 68 | $73K |
| Long-term disability(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 68 | $73K |
| Other(4 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 68 | $85K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 79 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.