| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GEORGE PETERSEN INSURANCE AGENCY3 | 175 WEST COLLEGE AVENUE SANTA ROSA, CA 95401 | KAISER FOUNDATION HEALTH PLAN INC | $62K | $0 | $62K | 1.99% |
| GEORGE PETERSEN INSURANCE AGENCY3 | 175 WEST COLLEGE AVENUE SANTA ROSA, CA 95401 | UNITEDHEALTHCARE INSURANCE COMPANY | $95K | $0 | $95K | 3.99% |
| GEORGE PETERSEN INSURANCE AGENCY3 | PO BOX 3539 SANTA ROSA, CA 95402 | PRINCIPAL LIFE INSURANCE COMPANY | $21K | $5K | $26K | 5.21% |
| LEBHERZ INSURANCE SERVICES INC3 Filed as: LEBHERZ INSURANCE SERVICES, INC. | 1600 WEST HILLSDALE BOULEVARD SUITE 201 SAN MATEO, CA 94402 | PRINCIPAL LIFE INSURANCE COMPANY | $15K | $3K | $18K | 3.51% |
| GEORGE PETERSEN INSURANCE AGENCY3 | 416 E STREET EUREKA, CA 95501 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | $0 | $1K | 15.00% |
| GEORGE PETERSEN INSURANCE AGENCY3 | 627 WEST COLLEGE AVENUE SANTA ROSA, CA 95404 | DELTA DENTAL | $505 | $0 | $505 | 10.01% |
| ROBERT M NISSIM3 Filed as: ROBERT M. NISSIM | 1038 BANCROFT ROAD CONCORD, CA 94518 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $540 | $0 | $540 | 18.16% |
| CORNELIUS J. BUTLER3 | 4254 DARDANELLES STREET SACRAMENTO, CA 95834 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $62 | $0 | $62 | 2.09% |
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 | 592 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 12 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 606 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 924 | $5.5M |
| Dental(3 contracts, 3 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 1,150 | $2.9M |
| Life insurance(2 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 1,150 | $2.9M |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 1,150 | $499K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 12 | $9K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 924 | $5.5M |
| Other(3 contracts, 3 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 1,150 | $505K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,150 | — |
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."
No prospect flags tripped on this filing.