Cal. Code Regs. Tit. 22, div. 1, 1, div. 1, pt. 2, ch. 6, tbl. 2 - Insurer Application #1

Item	Employer Statistics - As Required by CCR Section 3254(i) - 2(e)
(15)	Total number of employees eligible to be covered	100,000
(16)	Total number of consenting employees eligible to be covered	80,000
(17)	Number of female employees eligible to be covered	55,000
(18)	Number of male employees eligible to be covered	45,000
(19)	Number of employees aged 50 and older eligible to be covered	22,000
(20)	Number of employees paid less than the Annual Wage Threshold eligible to be covered	60,000

Item	Wage Test	Qualifier	Source
(21)	Percentage of Employees Earning Below the Annual Wage Threshold	60.0%	Item (20) divided by Item (15)
(22)	Minimum Percentage for Employment Below the Annual Wage Threshold	51.2%	Determined by Item (8), Table 1
(23)	Pass/Fail (Standard for Approval)	PASS	If Item (21) is equal to or more than Item (22) then PASS
Item	Gender	Qualifier	Source
(24)	Percentage of Female Employees	55.0%	Item (17) divided by Item (15)
(25)	Minimum Percentage of Employment - Female Employees	44.7%	Determined by Item (11), Table 1
(26)	Pass/Fail (Standard for Approval)	PASS	If Item (24) is equal to or more than Item (25) then PASS
Item	Age	Qualifier	Source
(27)	Percentage of Employment - Employees Aged 50 Years and Older	22.0%	Item (19) divided by Item (15)
(28)	Minimum Percentage of Employment - Employees Aged 50 Years and Older	20.7%	Determined by Item (14), Table 1
(29)	Pass/Fail (Standard for Approval)	PASS	If Item (27) is equal to or more than Item (28) then PASS
Overall Qualification	PASS	Based on passing Items (23), (26) & (29)

Notes

Cal. Code Regs. Tit. 22, div. 1, 1, div. 1, pt. 2, ch. 6, tbl. 2