| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GEORGE PETERSEN INSURANCE AGENCY3 Filed as: GEORGE PETERSEN INS. AGENCY, INC. | 175 WEST COLLEGE AVENUE SANTA ROSA, CA 95401 | KAISER FOUNDATION HEALTH PLAN INC | $13K | $0 | $13K | 2.68% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61187 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN INC | $12K | $0 | $12K | 2.43% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | KAISER FOUNDATION HEALTH PLAN INC | $6K | $0 | $6K | 1.31% |
| EMPLOYERS SELECT INSURANCE SERVICES3 Filed as: EMPLOYERS SELECT INS. SERVICES, INC | 5701 LONETREE BOULEVARD, SUITE 111 ROCKLIN, CA 95765 | KAISER FOUNDATION HEALTH PLAN INC | -$40 | $0 | -$40 | -0.01% |
| GEORGE PETERSEN INSURANCE AGENCY3 Filed as: GEORGE PETERSEN INS. AGENCY, INC. | UNKNOWN WEST SACRAMENTO, CA 95691 | BLUECROSS BLUESHIELD OF ILLINOIS | $5K | $0 | $5K | 2.57% |
| USI INSURANCE SERVICES LLC3 | 1039-A NORTH MCDOWELL BOULEVARD PETALUMA, CA 94954 | BLUECROSS BLUESHIELD OF ILLINOIS | $5K | $0 | $5K | 2.47% |
| GEORGE PETERSEN INSURANCE AGENCY3 Filed as: GEORGE PETERSEN INS. AGENCY, INC. | 175 WEST COLLEGE AVENUE SANTA ROSA, CA 95401 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | $0 | $3K | 2.75% |
| USI INSURANCE SERVICES LLC3 | 2800 WEST MARCH LANE, SUITE 100 STOCKTON, CA 95219 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | $0 | $2K | 1.71% |
| USI INSURANCE SERVICES LLC3 | 8000 NORMAN CENTER DRIVE, SUITE 400 BLOOMINGTON, MN 55437 | PRINCIPAL LIFE INSURANCE COMPANY | $955 | $0 | $955 | 0.85% |
| USI INSURANCE SERVICES LLC3 | 10940 WHITE ROCK ROAD RANCHO CORDOVA, CA 95670 | SUTTER HEALTH PLAN | $2K | $0 | $2K | 2.77% |
| GEORGE PETERSEN INSURANCE AGENCY3 Filed as: GEORGE PETERSEN INS. AGENCY, INC. | 175 WEST COLLEGE AVENUE SANTA ROSA, CA 95401 | SUTTER HEALTH PLAN | $2K | $0 | $2K | 2.56% |
| RUMBAUGH ONE INSURANCE SOLUTIONS3 Filed as: RUMBAUGH ONE INS. SOLUTIONS, INC. | 1390 BROADWAY, SUITE B-125 PLACERVILLE, CA 95667 | AFLAC | $175 | $46 | $221 | 8.40% |
| EMPLOYERS SELECT INSURANCE SERVICES3 | 5701 LONETREE BOULEVARD, SUITE 111 ROCKLIN, CA 95765 | AFLAC | $85 | $0 | $85 | 3.23% |
| ANDY B GLENN II3 Filed as: ANDY B. GLENN, II | 2999 DOUGLAS BOULEVARD, SUITE 180 ROSEVILLE, CA 95661 | AFLAC | $19 | $11 | $30 | 1.14% |
| JESSICA JOPES AND OTHER AGENTS3 | 1025 JULIE COURT CONCORD, CA 94518 | AFLAC | $18 | $0 | $18 | 0.68% |
| PROSPERO BENF. GROUP AND INS. SVCS.3 Filed as: PROSPERO BENEFITS GROUP & INS SVCS | 925 HIGHLAND POINTE DRIVE SUITE 190 ROSEVILLE, CA 95678 | AFLAC | $12 | $0 | $12 | 0.46% |
| REBECCA J HANEY3 Filed as: REBECCA J. HANEY | 825 TALBART STREET MARTINEZ, CA 94553 | AFLAC | $8 | $0 | $8 | 0.30% |
| JACE G KUERSTEN3 Filed as: JACE G. KUERSTEN | 1574 SAN FERNANDO DRIVE CORONA, CA 92882 | AFLAC | $7 | $0 | $7 | 0.27% |
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 | 212 | 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) | 212 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 84 | $747K |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 241 | $113K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 241 | $113K |
| Life insurance(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 241 | $115K |
| Short-term disability | AFLAC | 2 | $3K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 84 | $747K |
| Other(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 241 | $115K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 241 | — |
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.