| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLINTON POLLEY GROUP3 Filed as: CLINTON POLLEY GROUP, INC | 12150 TRIBUTARY POINT DR STE 200 GOLD RIVER, CA 95670 | KAISER FOUNDATION HEALTH PLAN INC | $139K | $0 | $139K | 4.81% |
| CLINTON POLLEY GROUP3 Filed as: CLINTON POLLEY GROUP, INC | 12150 TRIBUTARY POINT DR STE 200 GOLD RIVER, CA 95670 | KAISER FOUNDATION HEALTH PLAN INC. | $11K | $0 | $11K | 4.53% |
| ASCENSION INSURANCE AGENCY3 Filed as: ASCENSION BENEFIT & INSURANCE SOLUT | 1277 TREAT BLVD STE 400 WALNUT CREEK, CA 94597 | KAISER FOUNDATION HEALTH PLAN INC. | $356 | $0 | $356 | 0.15% |
| CLINTON POLLEY GROUP3 Filed as: CLINTON POLLEY GROUP INC | 12150 TRIBUTARY POINT DRIVE STE 200 GOLD RIVER, CA 95670 | UNION SECURITY INSURANCE COMPANY | $6K | $0 | $6K | 3.70% |
| CLINTON POLLEY GROUP3 | 12150 TRIBUTARY POINT DR. STE 200 GOLD RIVER, CA 95670 | UDC DENTAL OF CALIFORNIA | $2K | $0 | $2K | 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 | 340 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 341 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | KAISER FOUNDATION HEALTH PLAN INC | 317 | $3.1M |
| Dental(2 contracts, 2 carriers) | UNION SECURITY INSURANCE COMPANY | 262 | $171K |
| Vision | UNION SECURITY INSURANCE COMPANY | 262 | $154K |
| Other | ANTHEM BLUE CROSS | 213 | $2K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 317 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.