| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GEORGE PETERSEN INSURANCE AGENCY3 Filed as: GEORGE PETERSON INSURANCE AGENCY | 175 WEST COLLEGE AVENUE SANTA ROSA, CA 95401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $1K | $7K | 12.77% |
| GEORGE PETERSEN INSURANCE AGENCY3 Filed as: GEORGE PETERSON INSURANCE AGENCY | 175 WEST COLLEGE AVENUE SANTA ROSA, CA 95401 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $149 | $5K | 17.10% |
| GEORGE PETERSEN INSURANCE AGENCY3 Filed as: GEORGE PETERSON INSURANCE AGENCY | 175 WEST COLLEGE AVENUE SANTA ROSA, CA 95401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 7.78% |
| INTERWEST INSURANCE SERVICES, LLC3 | 3636 AMERICAN RIVER DRIVE SACRAMENTO, CA 95864 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $0 | $1K | 5.12% |
| RITCH, COLBY, EDWARD3 | 175 WEST COLLEGE AVENUE SANTA ROSA, CA 95401 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $492 | $0 | $492 | 2.37% |
| EMPLOYEE SERVICES INCORPORATED3 | PO BOX 6121 SANTA ROSA, CA 95406 | SUN LIFE ASSURANCE COMPANY OF CANADA | $891 | $0 | $891 | 5.65% |
| INTERWEST INSURANCE SERVICES, LLC3 | 8950 CAL CENTER DRIVE, BUILDING 3 SUITE 200 SACRAMENTO, CA 95826 | SUN LIFE ASSURANCE COMPANY OF CANADA | $85 | $0 | $85 | 0.54% |
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 | 194 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 3 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 203 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 161 | $1.6M |
| Life insurance(5 contracts, 4 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 194 | $146K |
| Short-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 191 | $81K |
| Long-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 191 | $81K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 161 | $1.6M |
| Other(5 contracts, 4 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 194 | $146K |
| 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."
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.
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.