| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | CALIFORNIA PHYSICIANS' SERVICE | $9K | — | $9K | 2.44% |
| POLENZANI BENEFITS & INSURANCE3 Filed as: POLENZANI BENEFITS & INS LLC | 3452 E. FOOTHILL BLVD. SUITE 514 PASADENA, CA 91107 | CALIFORNIA PHYSICIANS' SERVICE | $5K | — | $5K | 1.54% |
| POLENZANI BENEFITS & INSURANCE3 | SERVICES, LLC 3452 E. FOOTHILL BLVD., SUITE 514 PASADENA, CA 91107 | KAISER FOUNDATION HEALTH PLAN INC. | $9K | — | $9K | 2.86% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | KAISER FOUNDATION HEALTH PLAN INC. | $7K | — | $7K | 2.17% |
| POLENZANI BENEFITS & INSURANCE3 | 3452 E. FOOTHILL BLVD. SUITE 514 PASADENA, CA 91107 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 9.88% |
| POLENZANI BENEFITS & INSURANCE3 | SERVICES, LLC 3452 E. FOOTHILL BLVD., SUITE 514 PASADENA, CA 911073163 | VISION SERVICE PLAN | $363 | — | $363 | 3.55% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD., SUITE 100 PASADENA, CA 91107 | VISION SERVICE PLAN | $278 | — | $278 | 2.72% |
| POLENZANI BENEFITS & INSURANCE3 | SERVICES, LLC 3452 E. FOOTHILL BLVD., SUITE 514 PASADENA, CA 91107 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $867 | — | $867 | 9.02% |
| POLENZANI BENEFITS & INSURANCE3 | 3452 E. FOOTHILL BLVD. SUITE 514 PASADENA, CA 91107 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 14.99% |
| POLENZANI BENEFITS & INSURANCE3 | 3579 E. FOOTHILL BLVD SUITE 250 PASADENA, CA 91107 | UNITED CONCORDIA INSURANCE COMPANY | $2K | — | $2K | 172.10% |
| POLENZANI BENEFITS & INSURANCE3 | 3579 E. FOOTHILL BLVD. SUITE 250 PASADENA, CA 91107 | UNITED CONCORDIA INSURANCE COMPANY | $1 | — | $1 | 9.09% |
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 | 157 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 158 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE | 87 | $675K |
| Dental(2 contracts) | UNITED CONCORDIA INSURANCE COMPANY | 6 | $1K |
| Vision | VISION SERVICE PLAN | 77 | $10K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 115 | $37K |
| Long-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 115 | $39K |
| Prescription drug | CALIFORNIA PHYSICIANS' SERVICE | 32 | $350K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 115 | $37K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 115 | — |
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.