| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SSM INSURANCE SERVICES, INC.3 | 1 WILLOWBROOK COURT PENTALUMA, CA 94954 | CALIFORNIA PHYSICIANS SERVICE | $0 | $34K | $34K | 2.38% |
| INTERWEST INSURANCE SERVICES, LLC3 Filed as: INTERWEST INSURANCE SERVICES | 3636 AMERICAN RIVER DRIVE 2ND FLOOR SACRAMENTO, CA 95864 | CALIFORNIA PHYSICIANS SERVICE | $0 | $34K | $34K | 2.38% |
| SSM INSURANCE SERVICES, INC.3 | PO BOX 750004 PETALUMA, CA 94975 | KAISER FOUNDATION HEALTH PLAN INC | $14K | $7 | $14K | 2.16% |
| INTERWEST INSURANCE SERVICES, LLC Filed as: INTERWEST INSURANCE SERVICES, INC. | 8950 CAL CENTER DRIVE BUILDING 3, SUITE 200 SACRAMENTO, CA 95826 | KAISER FOUNDATION HEALTH PLAN INC | $14K | $0 | $14K | 2.12% |
| INTERWEST INSURANCE SERVICES, LLC3 | 5401 OLD REDWOOD HIGHWAY, SUITE 105 PETALUMA, CA 94954 | METROPOLITAN LIFE INSURANCE COMPANY | $11K | $0 | $11K | 5.03% |
| SSM INSURANCE SERVICES, INC.3 | PO BOX 750004 PETALUMA, CA 94975 | METROPOLITAN LIFE INSURANCE COMPANY | $9K | $0 | $9K | 3.80% |
| INTERWEST INSURANCE SERVICES, LLC3 Filed as: INTERWEST INSURANCE SERVICES | PO BOX 8110 CHICO, CA 95927 | VISION SERVICE PLAN | $849 | $0 | $849 | 3.40% |
| SSM INSURANCE SERVICES, INC.3 | PO BOX 750004 PETALUMA, CA 94975 | VISION SERVICE PLAN | $356 | $0 | $356 | 1.42% |
| ROSALIE KAY PARKS3 | 136 MARK WEST STATION ROAD WINDSOR, CA 95492 | AFLAC | $2K | $78 | $3K | 11.99% |
| MICHAEL J. MCVAY3 | 8967 CREST VIEW DRIVE CORONA, CA 92883 | AFLAC | $619 | $0 | $619 | 2.94% |
| MARK C. HUBER3 | 1260 NORTH DUTTON AVENUE, SUITE 180 SANTA ROSA, CA 95401 | AFLAC | $484 | $16 | $500 | 2.38% |
| CHRIS KELLY3 | 252 WIKIUP MEADOWS DRIVE SANTA ROSA, CA 95403 | AFLAC | $408 | $5 | $413 | 1.96% |
| LAURA RUNYEON3 Filed as: LAURA J. RUNYEON AND OTHER AGENTS | 2042 WEATHERBY WAY PETALUMA, CA 94954 | AFLAC | $315 | $0 | $315 | 1.50% |
| DAVID B. KITCHEN3 | 1260 NORTH DUTTON AVENUE, SUITE 180 SANTA ROSA, CA 95401 | AFLAC | $106 | $11 | $117 | 0.56% |
| JON P BATES JR3 Filed as: JON P. BATES, JR. | 440 REGENTS PARK DRIVE VALLEIO, CA 94591 | AFLAC | $76 | $0 | $76 | 0.36% |
| SSM INSURANCE SERVICES, INC.3 | PO BOX 750004 PETALUMA, CA 94975 | MANAGED HEALTH NETWORK | $237 | $0 | $237 | 2.59% |
| INTERWEST INSURANCE SERVICES, LLC3 | 1357 EAST LASSEN AVENUE CHICO, CA 95973 | MANAGED HEALTH NETWORK | $221 | $0 | $221 | 2.41% |
| ANGELA MONTENEGRO3 | 14 WALL STREET, SUITE 8C NEW YORK, NY 10005 | AFLAC | $451 | $0 | $451 | 9.31% |
| MARY RUSK3 | 230 EAST 7TH STREET APARTMENT 1C NEW YORK, NY 10021 | AFLAC | $433 | $0 | $433 | 8.94% |
| DOUGLAS MEIER3 Filed as: DOUGLAS R. MEIER | 23 ROCKLEDGE TERRACE POMPTON PLAINS, NJ 07444 | AFLAC | $107 | $0 | $107 | 2.21% |
| DEGATI & ASSOCIATES INC3 Filed as: DEGATI AND ASSOCIATES, INC. | 16059 23RD AVENUE WHITSTONE, NY 11357 | AFLAC | $95 | $0 | $95 | 1.96% |
| RICHARD PETERSON3 | 14107 20TH AVENUE, SUITE 507 WHITESTONE, NY 11357 | AFLAC | $43 | $0 | $43 | 0.89% |
| KENNETH C MEIER CORP3 Filed as: KENNETH C. MEIER CORPORATION | 401 FRANKLIN AVENUE, SUITE 312 GARDEN CITY, NY 11530 | AFLAC | $21 | $0 | $21 | 0.43% |
| BENITO A ROTONDI II INC3 Filed as: BENITO A TOTONDI II, INC. AND AGENT | 23 PINE RIDGE ROAD SARATOGA SPRINGS, NY 12866 | AFLAC | $6 | $0 | $6 | 0.12% |
| INTERWEST INSURANCE SERVICES, LLC3 | PO BOX 8110 CHICO, CA 95927 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $160 | $0 | $160 | 5.09% |
| SSM INSURANCE SERVICES, INC.3 | PO BOX 750004 PETALUMA, CA 94975 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $98 | $0 | $98 | 3.12% |
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 | 245 | 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) | 245 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 150 | $2.1M |
| Dental(4 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 314 | $254K |
| Vision(3 contracts, 2 carriers) | VISION SERVICE PLAN | 213 | $51K |
| Life insurance(3 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 314 | $251K |
| Short-term disability(2 contracts) | AFLAC | 31 | $26K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 314 | $225K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 150 | $2.1M |
| Other(4 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 314 | $260K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 314 | — |
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.