| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| POLENZANI BENEFITS & INSURANCE3 | SERVICES, LLC 3452 E. FOOTHILL BLVD., SUITE 514 PASADENA, CA 911073163 | KAISER FOUNDATION HEALTH PLAN INC. | $19K | — | $19K | 2.64% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911016030 | KAISER FOUNDATION HEALTH PLAN INC. | $10K | — | $10K | 1.33% |
| POLENZANI BENEFITS & INSURANCE3 | SERVICES, LLC 3579 E. FOOTHILL BLVD., SUITE 250 PASADENA, CA 911073119 | METROPOLITAN LIFE INSURANCE COMPANY | $7K | $97 | $7K | 8.32% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | METROPOLITAN LIFE INSURANCE COMPANY | $520 | — | $520 | 0.59% |
| POLENZANI BENEFITS & INSURANCE3 | SERVICES, LLC 3579 E. FOOTHILL BLVD., SUITE 250 PASADENA, CA 91107 | SAFEGUARD HEALTH PLANS, INC. | $941 | — | $941 | 9.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | SAFEGUARD HEALTH PLANS, INC. | $90 | — | $90 | 0.86% |
| POLENZANI BENEFITS & INSURANCE3 | SERVICES, LLC 3424 E. FOOTHILL BLVD., SUITE 514 PASADENA, CA 91107 | UNION SECURITY INSURANCE COMPANY | $876 | $190 | $1K | 16.74% |
| POLENZANI BENEFITS & INSURANCE3 | SERVICES, LLC 3424 E. FOOTHILL BLVD., SUITE 514 PASADENA, CA 91107 | UNION SECURITY INSURANCE COMPANY | $445 | $71 | $516 | 21.29% |
| POLENZANI BENEFITS & INSURANCE3 | SERVICES, LLC 3424 E. FOOTHILL BLVD., SUITE 514 PASADENA, CA 91107 | UNION SECURITY INSURANCE COMPANY | $401 | $54 | $455 | 21.10% |
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 | 0 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 128 | $732K |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 178 | $99K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 178 | $94K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 178 | $88K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 178 | $88K |
| Other(3 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 178 | $93K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 178 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.