| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CENTENNIAL GROUP BENEFITS3 | P.O. BOX 26457 SANTA ANA, CA 92799 | KAISER FOUNDATION HEALTH PLAN, INC. | $35K | — | $35K | 4.02% |
| CENTENNIAL GROUP BENEFITS3 | P.O. BOX 26457 SANTA ANA, CA 92799 | KAISER FOUNDATION HEALTH PLAN INC. | $21K | — | $21K | 4.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES INC | 3800 N. CENTRAL AVE., FLOOR 9 PHOENIX, AZ 85012 | UNITEDHEALTHCARE INSURANCE COMPANY | $8K | $5K | $13K | 3.89% |
| CENTENNIAL GROUP BENEFITS3 | 1500 QUAIL STREET, SUITE 100 NEWPORT BEACH, CA 92660 | PRINCIPAL LIFE INSURANCE COMPANY | $13K | $1K | $14K | 13.23% |
| GCG FINANCIAL LLC3 Filed as: ALERA GROUP, INC. DBA ARMS | 965 GREENTREE RD STE 110 PITTSBURGH, PA 15220 | PRINCIPAL LIFE INSURANCE COMPANY | — | $2K | $2K | 2.13% |
| CENTENNIAL GROUP BENEFITS3 | P.O. BOX 26457 SANTA ANA, CA 92799 | DELTA DENTAL OF CALIFORNIA | $8K | — | $8K | 8.00% |
| CENTENNIAL GROUP BENEFITS3 | P.O. BOX 26457 SANTA ANA, CA 92799 | DELTA DENTAL OF CALIFORNIA | $2K | — | $2K | 7.98% |
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 | 169 | 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) | 170 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 133 | $1.7M |
| Dental(2 contracts) | DELTA DENTAL OF CALIFORNIA | 199 | $124K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 299 | $109K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 299 | $109K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 299 | $109K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 299 | $109K |
| Prescription drug(2 contracts) | KAISER FOUNDATION HEALTH PLAN, INC. | 133 | $1.4M |
| Other | PRINCIPAL LIFE INSURANCE COMPANY | 299 | $109K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 299 | — |
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.