| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GEORGE PETERSEN INSURANCE AGENCY3 | 175 WEST COLLEGE AVENUE SANTA ROSA, CA 95401 | BLUE CROSS OF CALIFORNIA | $109K | $0 | $109K | 2.76% |
| GEORGE PETERSEN INSURANCE AGENCY3 | 175 WEST COLLEGE AVENUE SANTA ROSA, CA 95401 | KAISER FOUNDATION HEALTH PLAN INC | $53K | $0 | $53K | 2.31% |
| GEORGE PETERSEN INSURANCE AGENCY3 | 175 WEST COLLEGE AVENUE SANTA ROSA, CA 95401 | KAISER FOUNDATION HEALTH PLAN INC | $29K | $0 | $29K | 2.08% |
| GEORGE PETERSEN INSURANCE AGENCY3 | 175 WEST COLLEGE AVENUE SANTA ROSA, CA 95401 | PRINCIPAL LIFE INSURANCE COMPANY | $3K | $2K | $5K | 8.65% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 2677 NORTH MAIN STREET, SUITE 800 SANTA ANA, CA 92705 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | $0 | $2K | 3.00% |
| GEORGE PETERSEN INSURANCE AGENCY3 | PO BOX 3539 SANTA ROSA, CA 95402 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | $0 | $1K | 15.00% |
| ROBERT M NISSIM3 Filed as: ROBERT M. NISSIM | 1038 BANCROFT ROAD CONCORD, CA 94518 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $543 | $0 | $543 | 13.96% |
| MIILIONAIRES ON DECK ENTERPRISE LLC3 | 4254 DARDANELLES STREET SACRAMENTO, CA 95834 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $26 | $0 | $26 | 0.67% |
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 | 686 | 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) | 686 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 989 | $7.7M |
| Dental | BLUE CROSS OF CALIFORNIA | 989 | $4.0M |
| Vision | BLUE CROSS OF CALIFORNIA | 989 | $4.0M |
| Life insurance | BLUE CROSS OF CALIFORNIA | 989 | $4.0M |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 96 | $52K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 13 | $9K |
| Prescription drug(3 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 989 | $7.7M |
| Other(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 989 | $4.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 989 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.