| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GEORGE PETERSEN INSURANCE AGENCY3 Filed as: GEORGE PETERSON INSURANCE AGENCY | 175 WEST COLLEGE AVENUE SANTA ROSA, CA 95401 | KAISER FOUNDATION HEALTH PLAN, INC. | $36K | $0 | $36K | 5.10% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SVCS., LLC | 2677 NORTH MAIN STREET, SUITE 800 SANTA ANA, CA 92705 | KAISER FOUNDATION HEALTH PLAN, INC. | $20K | $0 | $20K | 2.78% |
| GEORGE PETERSEN INSURANCE AGENCY3 Filed as: GEORGE PETERSON INSURANCE AGENCY | 175 WEST COLLEGE AVENUE SANTA ROSA, CA 95401 | PRINCIPAL LIFE INSURANCE COMPANY | $12K | $3K | $15K | 11.45% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SVCS., LLC | 2677 NORTH MAIN STREET, SUITE 800 SANTA ANA, CA 92705 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | $0 | $3K | 2.73% |
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 | 211 | 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) | 211 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 211 | $710K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 261 | $127K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 261 | $127K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 261 | $127K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN, INC. | 211 | $710K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 261 | — |
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.