| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| POLENZANI BENEFITS & INSURANCE3 | SERVICES, LLC 3452 E. FOOTHILL BLVD., SUITE 514 PASADENA, CA 91107 | HEALTH NET | $21K | $4K | $26K | 4.32% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | HEALTH NET | $10K | — | $10K | 1.61% |
| POLENZANI BENEFITS & INSURANCE3 | SERVICES, LLC 3452 E. FOOTHILL BLVD., SUITE 514 PASADENA, CA 91107 | KAISER FOUNDATION HEALTH PLAN INC. | $6K | — | $6K | 5.00% |
| POLENZANI BENEFITS & INSURANCE3 | SERVICES, LLC 3452 E. FOOTHILL BLVD., SUITE 514 PASADENA, CA 91107 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $10K | — | $10K | 17.97% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $846 | — | $846 | 1.58% |
| POLENZANI BENEFITS & INSURANCE3 | SERVICES, LLC 3452 E. FOOTHILL BLVD., SUITE 514 PASADENA, CA 91107 | UNICARE LIFE & HEALTH INSURANCE COMPANY | $5K | — | $5K | 9.99% |
| POLENZANI BENEFITS & INSURANCE3 | SERVICES, LLC 3452 E. FOOTHILL BLVD., SUITE 514 PASADENA, CA 91107 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | $97 | $6K | 15.76% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | GERBER LIFE INSURANCE CO. | $760 | — | $760 | 7.61% |
| POLENZANI BENEFITS & INSURANCE3 | SERVICES, LLC 3452 E. FOOTHILL BLVD., SUITE 514 PASADENA, CA 91107 | GERBER LIFE INSURANCE CO. | $186 | $574 | $760 | 7.61% |
| POLENZANI BENEFITS & INSURANCE3 | SERVICES, LLC 3452 N. FOOTHILL BLVD., SUITE 514 PASADENA, CA 91107 | COMBINED INSURANCE COMPANY OF AMERICA | $317 | — | $317 | 7.04% |
| CYNTHIA LERNER RUBIN3 Filed as: CYNTHIA BENGSTON | — | COMBINED INSURANCE COMPANY OF AMERICA | $282 | — | $282 | 6.27% |
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 | 128 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 128 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | HEALTH NET | 87 | $717K |
| Dental | UNICARE LIFE & HEALTH INSURANCE COMPANY | 96 | $47K |
| Vision | GERBER LIFE INSURANCE CO. | 70 | $10K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 162 | $35K |
| Short-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 162 | $35K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 162 | $35K |
| Prescription drug | HEALTH NET | 87 | $595K |
| Other(3 contracts, 3 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 162 | $93K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 162 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.