| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NTH INSURANCE AGENCY INC.3 Filed as: THE NTH INSURANCE AGENCY, INC. | 10833 VALLEY VIEW STE 550 CYPRESS, CA 90630 | CALIFORNIA PHYSICIANS' SERVICE (BLUE SHIELD OF CALIFORNIA) | $7K | $51K | $57K | 5.59% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INSURANCE & FIN. SVCS. | 6200 CANOGA AVENUE SUITE 300 WOODLAND HILLS, CA 91367 | CALIFORNIA PHYSICIANS' SERVICE (BLUE SHIELD OF CALIFORNIA) | $22K | $60 | $22K | 2.10% |
| NTH INSURANCE AGENCY INC.3 Filed as: THE NTH INSURANCE AGENCY, INC. | 10833 VALLEY VIEW STE 550 CYPRESS, CA 90630 | KAISER FOUNDATION HEALTH PLAN, INC. | $5K | — | $5K | 4.79% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INSURANCE & FIN. SVCS. | 12404 PARK CENTRAL DR SUITE #400S DALLAS, TX 75251 | KAISER FOUNDATION HEALTH PLAN, INC. | $927 | — | $927 | 0.85% |
| NTH INSURANCE AGENCY INC.3 Filed as: THE NTH INSURANCE AGENCY, INC. | 10833 VALLEY VIEW STE 550 CYPRESS, CA 90630 | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | $2K | — | $2K | 15.00% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INSURANCE & FIN. SVCS. | 6200 CANOGA AVENUE SUITE 300 WOODLAND HILLS, CA 91367 | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | $206 | — | $206 | 2.00% |
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 | 127 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 127 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE (BLUE SHIELD OF CALIFORNIA) | 162 | $1.1M |
| Dental | CALIFORNIA PHYSICIANS' SERVICE (BLUE SHIELD OF CALIFORNIA) | 162 | $1.0M |
| Vision | CALIFORNIA PHYSICIANS' SERVICE (BLUE SHIELD OF CALIFORNIA) | 162 | $1.0M |
| Life insurance | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | 127 | $10K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS' SERVICE (BLUE SHIELD OF CALIFORNIA) | 162 | $1.1M |
| Other | BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | 127 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 162 | — |
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.