| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLINTON POLLEY GROUP3 Filed as: CLINTON POLLEY GROUP, INC. | 12150 TRIBUTARY POINT DR SUITE 200 GOLD RIVER, CA 956704531 | KAISER FOUNDATION HEALTH PLAN INC. | $41K | $0 | $41K | 2.96% |
| DANONE SIMPSON INSURANCE SERVICES3 Filed as: DANONE SIMPSON INS. SERVICES, LLC | 5550 TOPANGA CANYON BLVD SUITE 310 WOODLAND HILLS, CA 913677444 | KAISER FOUNDATION HEALTH PLAN INC. | $23K | $0 | $23K | 1.66% |
| CLINTON POLLEY GROUP3 Filed as: CLINTON POLLEY GROUP INC. | 12150 TRIBUTARY POINT DR SUITE 200 GOLD RIVER, CA 956704531 | PRINCIPAL LIFE INSURANCE COMPANY | $5K | $0 | $5K | 3.61% |
| DANONE SIMPSON INSURANCE SERVICES3 Filed as: DANONE SIMPSON INS. SERVICES LLC | DBA MONTAGE INSURANCE SOLUTIONS 5550 TOPANGA CANYON BLVD, SUITE 310 WOODLAND HILLS, CA 913677444 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | $0 | $2K | 1.40% |
| BENEFITS AMERICA INSURANCE SERVICES3 | 6320 CANOGA AVE. 12TH FLOOR WOODLAND HILLS, CA 91367 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 16.33% |
| BENEFITS AMERICA INSURANCE SERVICES3 | 1800 QUAIL STREET SUITE 110 NEWPORT BEACH, CA 92660 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $109 | $109 | 0.56% |
| BENEFITS AMERICA INSURANCE SERVICES3 | 6320 CANOGA AVE. 12TH FLOOR WOODLAND HILLS, CA 91367 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 10.47% |
| DANONE SIMPSON INSURANCE SERVICES3 | 5550 TOPANGA CANYON BLVD SUITE 300 WOODLAND HILLS, CA 91367 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $0 | $1K | 5.68% |
| BENEFITS AMERICA INSURANCE SERVICES3 | 1800 QUAIL STREET SUITE 110 NEWPORT BEACH, CA 92660 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $44 | $44 | 0.24% |
| CLINTON POLLEY GROUP3 Filed as: CLINTON POLLEY INSURANCE BROKERS | 12150 TRIBUTARY POINT DR. #200 GOLD RIVER, CA 95670 | CALIFORNIA DENTAL NETWORK, INC. | $574 | $0 | $574 | 5.97% |
| DANONE SIMPSON INSURANCE SERVICES3 Filed as: DANONE SIMPSON | 5550 TOPANGA CANYON BLVD. #310 WOODLAND HILLS, CA 91367 | CALIFORNIA DENTAL NETWORK, INC. | $388 | $0 | $388 | 4.03% |
| CLINTON POLLEY GROUP3 Filed as: CLINTON POLLEY GROUP, INC. | 12150 TRIBUTARY PT DRIVE 200 GOLD RIVER, CA 95670 | MANAGED HEALTH NETWORK | $374 | $0 | $374 | 5.86% |
| DANONE SIMPSON INSURANCE SERVICES3 Filed as: DANONE SIMPSON INS. SERVICES LLC | 5550 TOPANGA CANYON BLVD SUITE 310 WOODLAND HILLS, CA 91367 | MANAGED HEALTH NETWORK | $264 | $0 | $264 | 4.14% |
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 | 226 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 228 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 221 | $1.4M |
| Dental(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 275 | $142K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 275 | $132K |
| Life insurance(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 275 | $151K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 21 | $19K |
| Other(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 227 | $25K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 275 | — |
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.