| 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. | $12K | — | $12K | 0.87% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | BLUE CROSS OF CALIFORNIA | $11K | — | $11K | 2.02% |
| POLENZANI BENEFITS & INSURANCE3 | SERVICES 3579 E. FOOTHILL BVD., SUITE 250 PASADENA, CA 91107 | BLUE CROSS OF CALIFORNIA | $6K | — | $6K | 1.18% |
| POLENZANI BENEFITS & INSURANCE3 | SERVICES LLC 3452 E. FOOTHILL BLVD., SUITE 514 PASADENA, CA 91107 | UNION SECURITY INSURANCE COMPANY | $11K | — | $11K | 3.72% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | UNION SECURITY INSURANCE COMPANY | $4K | — | $4K | 1.50% |
| POLENZANI BENEFITS & INSURANCE3 | SERVICES LLC 3452 E. FOOTHILL BLVD., SUITE 514 PASADENA, CA 91107 | UDC DENTAL OF CALIFORNA, INC. | $1K | — | $1K | 4.91% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | UDC DENTAL OF CALIFORNA, INC. | $1K | — | $1K | 4.60% |
| BRIAN YERVANT AKIAN3 | 503 SPRINGBROOK NORTH IRVINE, CA 92614 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $484 | $58 | $542 | 4.38% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $155 | — | $155 | 1.25% |
| POLENZANI BENEFITS & INSURANCE3 Filed as: POLENZANI BENEFITS AND INSURANCE | SERVICES 3452 E. FOOTHILL BLVD., SUITE 514 PASADENA, CA 91107 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $103 | — | $103 | 0.83% |
| MICHAEL F FAHEY III3 Filed as: MICHAEL F. FAHEY | 411 AVENIDA ADOBE SAN CLEMENTE, CA 92672 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $87 | $11 | $98 | 0.79% |
| DAVID A. RACKLIFFE3 | 35 DANBURY LANE IRVINE, CA 92618 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $77 | — | $77 | 0.62% |
| ERIC TERRAZAS3 | 2101 IPSEN WAY PLACENTIA, CA 92870 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $14 | — | $14 | 0.11% |
| MIKE MCCORMICK3 | 348 S. STRONGS CT. SALT LAKE CITY, UT 84102 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3 | — | $3 | 0.02% |
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 | 450 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 451 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 511 | $1.9M |
| Dental(2 contracts, 2 carriers) | UNION SECURITY INSURANCE COMPANY | 450 | $323K |
| Vision | UNION SECURITY INSURANCE COMPANY | 450 | $293K |
| Life insurance(2 contracts, 2 carriers) | UNION SECURITY INSURANCE COMPANY | 450 | $305K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 14 | $12K |
| Long-term disability | UNION SECURITY INSURANCE COMPANY | 450 | $293K |
| Other(2 contracts, 2 carriers) | UNION SECURITY INSURANCE COMPANY | 450 | $305K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 511 | — |
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."
No prospect flags tripped on this filing.