Form 5500 · Employee benefit plan · CITY OF INDUSTRY, CA
R. H. PETERSON CO.
The filing calls this plan R. H. PETERSON CO. PREMIUM CONVERSION PLAN.
Public Form 5500 records show how R. H. PETERSON CO. of CITY OF INDUSTRY, CA, a wholesale trade employer, structures its employee benefits. Its broker of record is PROFESSIONAL GROUP PLANS, INC.. Coverage is written through KAISER FOUNDATION HEALTH PLAN, INC. and 2 other carriers. The plan's most recent policy period ended in July.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 95-3137229 · plan 502 · plan year 2025, filed Feb 6, 2026
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How this plan is funded
Both, as reported
The medical insurance contracts on the filing cover fewer than half the people in the plan, so the rest is paid another way.
A stop-loss policy appears on a Form 5500 only when the plan itself is the beneficiary, or the premiums are paid from plan money. Many employers buy stop-loss and never report it here. So a plan with no stop-loss on its filing may still have it.
Benefits declared on this filing
Health: KAISER FOUNDATION HEALTH PLAN, INC. covers 19 of 212 participants (9%) on Schedule A.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 3 insured contracts covering health, dental, vision, life and disability.
Reported premium across the insured contracts is $304,915, with $29,811 in disclosed broker commissions — about 9.8% of premium.
The most recent policy period ended in July, and the plan year ends July 31. Group contracts typically renew on that annual cycle.
PROFESSIONAL GROUP PLANS, INC. is the broker of record on 1 of the 3 contracts; the rest name a different broker or none.
3 carriers appear on the filing, including KAISER FOUNDATION HEALTH PLAN, INC., HARTFORD LIFE AND ACCIDENT and THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA. KAISER FOUNDATION HEALTH PLAN, INC. writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| HARTFORD LIFE AND ACCIDENT | Life, Disability | 202 | Aug 1, 2025 | $80,261 | $15,420 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | Dental, Vision | 114 | Aug 1, 2025 | $50,454 | $7,568 |
| KAISER FOUNDATION HEALTH PLAN, INC. | Health | 19 | Aug 1, 2025 | $174,200 | $6,823 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Reported to OSHA
Reported to OSHA for 2025: 220 employees, 6 recordable cases, 73 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
How this plan compares
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