| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | CALIFORNIA PHYSICIANS SERVICE | $34K | — | $34K | 3.19% |
| ROGERS BENEFIT GROUP INC3 Filed as: WELDON G. KERR/RBG SAN JOSE | 6155 ALMADEN EXPWY #210 SAN JOSE, CA 95112 | CALIFORNIA PHYSICIANS SERVICE | $25K | — | $25K | 2.38% |
| GEORGE PETERSEN INSURANCE AGENCY3 Filed as: GEORGE PETERSON INSURANCE AGENCY | 175 W. COLLEGE AVE SANTA ROSA, CA 95401 | CALIFORNIA PHYSICIANS SERVICE | $19K | — | $19K | 1.81% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 900 E. HAMILTON AVE.#500 CAMPBELL, CA 950080667 | KAISER FOUNDATION HEALTH PLAN, INC. | $14K | — | $14K | 1.59% |
| GEORGE PETERSEN INSURANCE AGENCY3 Filed as: GEORGE PETERSON INSURANCE AGENCY | 175 W. COLLEGE AVE SANTA ROSA, CA 954016503 | KAISER FOUNDATION HEALTH PLAN, INC. | $9K | — | $9K | 1.06% |
| ASSUREDPARTNERS3 Filed as: EMERSON ROGERS, LLC | 1787 SENTRY PKWY W, SUITE 320 BLDG 16 BLUE BELL, PA 194222240 | METROPOLITAN LIFE INSURANCE COMPANY | $8K | $2K | $10K | 6.24% |
| FILICE INSURANCE AGENCY3 | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | — | $3K | 2.08% |
| GEORGE PETERSEN INSURANCE AGENCY3 Filed as: GEORGE PETERSON INSURANCE AGENCY | P.O. BOX 3539 SANTA ROSA, CA 954023539 | METROPOLITAN LIFE INSURANCE COMPANY | $1K | — | $1K | 0.71% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 738 N. FIRST ST., SUITE 202 SAN JOSE, CA 95112 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $4K | 10.54% |
| GEORGE PETERSEN INSURANCE AGENCY3 Filed as: GEORGE PETERSON INSURANCE AGENCY | 175 W. COLLEGE AVE SANTA ROSA, CA 95401 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 3.39% |
| FILICE INSURANCE AGENCY3 Filed as: FILICE INSURANCE AGENCY, INC. | 900 E. HAMILTON AVE.#500 CAMPBELL, CA 950080667 | VISION SERVICE PLAN | $1K | — | $1K | 5.87% |
| GEORGE PETERSEN INSURANCE AGENCY3 Filed as: GEORGE PETERSON INSURANCE AGENCY | PO BOX 3539 SANTA ROSA, CA 954023539 | VISION SERVICE PLAN | $713 | — | $713 | 3.20% |
| DAN MICHELINI3 | 1150 MORAGA WAY MORAGA, CA 94556 | LANDMARK HEALTHPLAN | $892 | — | $892 | 10.00% |
| COLBY E. RITCH3 Filed as: COLBY RITCH | 175 W. COLLEGE AVE SANTA ROSA, CA 95401 | LANDMARK HEALTHPLAN | $892 | — | $892 | 10.00% |
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 | 334 | 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) | 334 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 102 | $1.9M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 334 | $161K |
| Vision(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 103 | $1.1M |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 114 | $42K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 114 | $42K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE | 102 | $1.9M |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 114 | $51K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 334 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.