Form 5500 · Employee benefit plan · PASADENA, CA
PASADENA HUMANE SOCIETY
The filing calls this plan PASADENA HUMANE SOCIETY WELFARE BENEFITS PLAN.
PASADENA HUMANE SOCIETY of PASADENA, CA is a 140-participant professional services employer whose group benefits are disclosed in its annual Form 5500 filing. Its broker of record is BENEFITS AMERICA INSURANCE SERVICES. Coverage is written through BLUE CROSS OF CALIFORNIA and 4 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 95-1643344 · plan 501 · plan year 2024, filed Sep 10, 2025
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 8 insured contracts covering health, dental, vision, life and disability; the largest, with BLUE CROSS OF CALIFORNIA, covers 128 people.
Reported premium across the insured contracts is $1,332,151, with $72,645 in disclosed broker commissions — about 5.5% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
BENEFITS AMERICA INSURANCE SERVICES is the broker of record on all 8 contracts.
5 carriers appear on the filing, including BLUE CROSS OF CALIFORNIA, DELTA DENTAL OF CALIFORNIA, EYEMED VISION CARE and UNITED OF OMAHA LIFE INSURANCE COMPANY. BLUE CROSS OF CALIFORNIA writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUE CROSS OF CALIFORNIA | Health | 128 | Jan 1, 2025 | $1,234,070 | $60,631 |
| DELTA DENTAL OF CALIFORNIA | Dental | 59 | Jan 1, 2025 | $36,811 | $3,681 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life | 54 | Jan 1, 2025 | $10,003 | $2,001 |
| DELTA DENTAL OF CALIFORNIA | Dental | 54 | Jan 1, 2025 | $17,930 | $1,793 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life | 141 | Jan 1, 2025 | $8,793 | $1,759 |
| EYEMED VISION CARE | Vision | 132 | Jan 1, 2025 | $13,018 | $1,293 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Disability | 141 | Jan 1, 2025 | $10,238 | $1,229 |
| MUTUAL OF OMAHA INSURANCE COMPANY | — | 85 | Jan 1, 2025 | $1,288 | $258 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Other plans filed by this employer
How this plan compares
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