| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 10940 WHITE ROCK ROAD, 2ND FLOOR RANCHO CORDOVA, CA 95670 | CALIFORNIA PHYSICIANS SERVICE | $19K | $0 | $19K | 4.06% |
| GEORGE PETERSEN INSURANCE AGENCY3 Filed as: GEORGE PETERSON INSURANCE AGENCY | 175 WEST COLLEGE AVENUE SANTA ROSA, CA 95401 | CALIFORNIA PHYSICIANS SERVICE | $4K | $0 | $4K | 0.94% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 1039 NORTH MCDOWELL BOULEVARD SUITE A PETALUMA, CA 94954 | KAISER FOUNDATION HEALTH PLAN INC | $12K | $0 | $12K | 4.87% |
| GEORGE PETERSEN INSURANCE AGENCY3 Filed as: GEORGE PETERSON INSURANCE AGENCY | 175 WEST COLLEGE AVENUE SANTA ROSA, CA 95401 | KAISER FOUNDATION HEALTH PLAN INC | $2K | $0 | $2K | 0.89% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: WELLS FARGO INSURANCE | 10940 WHITE ROCK ROAD RANCHO CORDOVA, CA 95670 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $5K | $0 | $5K | 6.00% |
| GEORGE PETERSEN INSURANCE AGENCY3 Filed as: GEORGE PETERSON INSURANCE AGENCY | 175 WEST COLLEGE AVENUE SANTA ROSA, CA 95401 | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | $2K | $0 | $2K | 1.75% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 1039 NORTH MCDOWELL BOULEVARD SUITE A PETALUMA, CA 94954 | BLUE CROSS OF CALIFORNIA | $2K | $0 | $2K | 6.49% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | 213 SOUTH JEFFERSON STREET SW ROANOKE, VA 24011 | BLUE CROSS OF CALIFORNIA | $637 | $760 | $1K | 5.64% |
| GEORGE PETERSEN INSURANCE AGENCY3 Filed as: GEORGE PETERSON INSURANCE AGENCY | 1960 CALIFORNIA STREET REDDING, CA 96001 | BLUE CROSS OF CALIFORNIA | $231 | $0 | $231 | 0.93% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 601146 CHARLOTTE, NC 28260 | MANAGED HEALTH NETWORK | $131 | $0 | $131 | 4.18% |
| GEORGE PETERSEN INSURANCE AGENCY3 Filed as: GEORGE PETERSON INSURANCE AGENCY | 175 WEST COLLEGE AVENUE SANTA ROSA, CA 95401 | MANAGED HEALTH NETWORK | $26 | $0 | $26 | 0.83% |
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 | 190 | 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) | 190 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 86 | $729K |
| Dental | NATIONAL GUARDIAN LIFE INSURANCE COMPANY | 267 | $88K |
| Vision | BLUE CROSS OF CALIFORNIA | 234 | $25K |
| Life insurance | BLUE CROSS OF CALIFORNIA | 234 | $25K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 86 | $729K |
| Other(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 234 | $28K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 267 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.