| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | BLUE CROSS OF CALIFORNIA | $45K | — | $45K | 4.77% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INSURANCE AND FIN. SVCS | 4851 LBJ FREEWAY, SUITE 1100 DALLAS, TX 75244 | BLUE CROSS OF CALIFORNIA | — | $18K | $18K | 1.95% |
| THOMAS M. NIAL3 | 801 RIM CREST DRIVE WESTLAKE VILLAGE, CA 91361 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $7K | — | $7K | 7.50% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INSURANCE AND FIN. SVCS | 4851 LBJ FREEWAY, SUITE 1100 DALLAS, TX 75244 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $2K | — | $2K | 2.50% |
| ROBERT G. RELPH AGENCY, INC.3 Filed as: ROBERT C. RASMUSSEN | 171 E. THOUSAND OAKS BLVD., STE 208 THOUSAND OAKS, CA 91360 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $2K | — | $2K | 2.50% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $1K | — | $1K | 4.77% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INSURANCE AND FIN. SVCS | 4851 LBJ FREEWAY, SUITE 1100 DALLAS, TX 75244 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | — | $598 | $598 | 1.95% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | ANTHEM LIFE INSURANCE COMPANY | $377 | — | $377 | 4.77% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INSURANCE AND FIN. SVCS | 4851 LBJ FREEWAY, SUITE 1100 DALLAS, TX 75244 | ANTHEM LIFE INSURANCE COMPANY | — | $154 | $154 | 1.95% |
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 | 98 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 99 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 98 | $939K |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 99 | $96K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 98 | $31K |
| Life insurance | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 98 | $31K |
| Long-term disability | ANTHEM LIFE INSURANCE COMPANY | 98 | $8K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 98 | $939K |
| Other | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 98 | $31K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 99 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.