| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| POLENZANI BENEFITS & INSURANCE3 | SERVICES, LLC 3452 E. FOOTHILL BLVD., SUITE 514 PASADENA, CA 91107 | KAISER FOUNDATION HEALTH PLAN INC. | $63K | — | $63K | 4.13% |
| POLENZANI BENEFITS & INSURANCE3 | SERVICES 3452 E. FOOTHILL BLVD., SUITE 514 PASADENA, CA 91107 | BLUE CROSS OF CALIFORNIA | $25K | — | $25K | 3.58% |
| POLENZANI BENEFITS & INSURANCE3 | SERVICES, LLC 3452 E. FOOTHILL BLVD., SUITE 514 PASADENA, CA 91107 | UNION SECURITY INSURANCE COMPANY | $14K | $6K | $19K | 8.62% |
| POLENZANI BENEFITS & INSURANCE3 | SERVICES LLC 3452 E. FOOTHILL BLVD., SUITE 514 PASADENA, CA 91107 | UDC DENTAL OF CALIFORNIA, INC. | $2K | $393 | $3K | 12.40% |
| BRIAN YERVANT AKIAN3 | 503 SPRINGBROOK NORTH IRVINE, CA 92614 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $411 | $14 | $425 | 3.87% |
| POLENZANI BENEFITS & INSURANCE3 Filed as: POLENZANI BENEFITS AND INSURANCE | SERVICES 3452 E. FOOTHILL BLVD., SUITE 514 PASADENA, CA 91107 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $247 | — | $247 | 2.25% |
| DAVID A. RACKLIFFE3 | 35 DANBURY LANE IRVINE, CA 92618 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $88 | — | $88 | 0.80% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F. FAHEY | 411 AVENIDA ADOBE SAN CLEMENTE, CA 92672 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $80 | $5 | $85 | 0.77% |
| ERIC TERRAZAS3 | 2101 IPSEN WAY PACENTIA, CA 92870 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | $1 | $8 | 0.07% |
| EUNICE AKIAN3 | 15551 WILD PLUM CIRCLE HUNTINGTON BEACH, CA 92647 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.03% |
| MIKE MCCORMICK3 | 348 S. STRONGS CT. SALK LAKE CITY, UT 84102 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.03% |
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 | 367 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 368 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 385 | $2.2M |
| Dental(2 contracts, 2 carriers) | UNION SECURITY INSURANCE COMPANY | 367 | $247K |
| Vision | UNION SECURITY INSURANCE COMPANY | 367 | $224K |
| Life insurance(2 contracts, 2 carriers) | UNION SECURITY INSURANCE COMPANY | 367 | $235K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 14 | $11K |
| Long-term disability | UNION SECURITY INSURANCE COMPANY | 367 | $224K |
| Other(2 contracts, 2 carriers) | UNION SECURITY INSURANCE COMPANY | 367 | $235K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 385 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.