| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLINTON POLLEY GROUP3 | 12150 TRIBUTARY POINT DR STE 200 GOLD RIVER, CA 95670 | KAISER PERMANENTE | $35K | $0 | $35K | 3.39% |
| ASCENSION INSURANCE AGENCY3 Filed as: ASCENSION BENEFIT & INSURANCE | 1277 TREAT BLVD STE 400 WALNUT CREEK, CA 94597 | KAISER PERMANENTE | $3K | $0 | $3K | 0.28% |
| CLINTON POLLEY GROUP3 | 12150 TRIBUTARY POINT DR STE 200 GOLD RIVER, CA 95670 | METROPOLOTIAN LIFE INSUREANCE COMPANY | $3K | $23 | $3K | 2.90% |
| PORTAL INSURANCE AGENCY, INC.3 Filed as: PORTAL INS AGENCY INC | 1277 TREAT BLVD STE 400 WALNUT CREEK, CA 94597 | METROPOLOTIAN LIFE INSUREANCE COMPANY | $303 | $0 | $303 | 0.25% |
| CLINTON POLLEY GROUP3 Filed as: CLINTON POLLEY GROUP INC | 12150 TRIBUTARY POINT DR STE 200 GOLD RIVER, CA 95670 | PRINCIPAL LIFE INSURANCE COMPANY | $4K | $0 | $4K | 10.23% |
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 | 199 | 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) | 199 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER PERMANENTE | 135 | $1.0M |
| Dental | METROPOLOTIAN LIFE INSUREANCE COMPANY | 165 | $119K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 199 | $37K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 199 | $37K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 199 | $37K |
| Prescription drug | KAISER PERMANENTE | 135 | $1.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 199 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.