| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GEORGE PETERSEN INSURANCE AGENCY3 | 175 WEST COLLEGE AVENUE SANTA ROSA, CA 95401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $0 | $6K | 10.91% |
| GEORGE PETERSEN INSURANCE AGENCY3 | 175 WEST COLLEGE AVENUE SANTA ROSA, CA 95401 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 10.98% |
| RITCH, COLBY, EDWARD3 | 175 WEST COLLEGE AVENUE SANTA ROSA, CA 95401 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $653 | $0 | $653 | 2.18% |
| RITCH, COLBY, EDWARD3 | 175 WEST COLLEGE AVENUE SANTA ROSA, CA 95401 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $435 | $0 | $435 | 1.87% |
| EMPLOYER SERVICES INCORPORATED3 | PO BOX 6121 SANTA ROSA, CA 95406 | SUN LIFE ASSURANCE COMPANY OF CANADA | $856 | $0 | $856 | 6.87% |
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 | 158 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 160 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 142 | $1.2M |
| Life insurance(4 contracts, 4 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 194 | $118K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 158 | $52K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 158 | $52K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 142 | $1.2M |
| Other(4 contracts, 4 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 194 | $118K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 194 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.