| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CENTENNIAL GROUP BENEFITS3 | 245 FISCHER AVE STE A2 COSTA MESA, CA 92626 | CALIFORNIA PHYSICIANS' SERVICE (BLUE SHIELD OF CALIFORNIA) | $31K | — | $31K | 5.00% |
| CENTENNIAL GROUP BENEFITS3 | P.O. BOX 26457 SANTA ANA, CA 92799 | KAISER FOUNDATION HEALTH PLAN INC. | $14K | — | $14K | 5.00% |
| CENTENNIAL GROUP BENEFITS3 | P.O. BOX 26457 SANTA ANA, CA 92799 | KAISER FOUNDATION HEALTH PLAN INC. | $12K | — | $12K | 5.00% |
| CENTENNIAL GROUP BENEFITS3 | P.O. BOX 26457 SANTA ANA, CA 92799 | SUN LIFE ASSURANCE COMPANY OF CANADA | $7K | — | $7K | 10.00% |
| CENTENNIAL GROUP BENEFITS3 Filed as: CENTENNIAL GROUP BENEFITS & INS SVC | P.O. BOX 3387 SEAL BEACH, CA 90740 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $2K | — | $2K | 10.03% |
| CENTENNIAL GROUP BENEFITS3 Filed as: CENTENNIAL GROUP BENEFITS & INS SVC | P.O. BOX 3387 SEAL BEACH, CA 90740 | BLUE CROSS OF CALIFORNIA | $6 | — | $6 | 10.17% |
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 | 140 | 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) | 141 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | CALIFORNIA PHYSICIANS' SERVICE (BLUE SHIELD OF CALIFORNIA) | 85 | $1.1M |
| Dental | SUN LIFE ASSURANCE COMPANY OF CANADA | 140 | $71K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 135 | $15K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 140 | $71K |
| Prescription drug(4 contracts, 3 carriers) | CALIFORNIA PHYSICIANS' SERVICE (BLUE SHIELD OF CALIFORNIA) | 85 | $1.1M |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 140 | $71K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 140 | — |
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.