| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CENTENNIAL GROUP BENEFITS3 | P.O. BOX 26457 SANTA ANA, CA 92799 | BLUE CROSS OF CALIFORNIA | $71K | — | $71K | 4.95% |
| CENTENNIAL GROUP BENEFITS INSURANCE3 | P.O. BOX 26457 SANTA ANA, CA 92799 | KAISER FOUNDATION HEALTH PLAN INC. | $45K | $73 | $45K | 4.75% |
| CENTENNIAL GROUP BENEFITS INSURANCE3 | P.O. BOX 26457 SANTA ANA, CA 92799 | UNION SECURITY INSURANCE COMPANY | $21K | — | $21K | 8.31% |
| CENTENNIAL GROUP BENEFITS INSURANCE3 | P.O. BOX 26457 SANTA ANA, CA 92799 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $12K | — | $12K | 15.00% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $3K | $3K | 4.00% |
| CENTENNIAL GROUP BENEFITS INSURANCE3 | 1500 QUAIL STREET, SUITE 100 NEWPORT BEACH, CA 92660 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $2K | — | $2K | 10.00% |
| CENTENNIAL GROUP BENEFITS3 | P.O. BOX 26457 SANTA ANA, CA 92799 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $21 | $1K | 9.10% |
| JOHN D EVANGELISTA3 Filed as: JOHN D. EVANGELISTA | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $713 | $237 | $950 | 7.91% |
| BENEFITS COORDINATOR3 | P.O. BOX 727 ARTESIA, CA 92702 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $514 | $169 | $683 | 5.69% |
| ALEXANDER OTTONIEL CANAS3 | 26123 BOUQUET CANYON ROAD SANTA CLARITA, CA 91350 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $149 | $40 | $189 | 1.57% |
| STEPHEN W DOUGLASS3 Filed as: STEPHEN W. DOUGLAS | 45 MORNING GLORY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $127 | — | $127 | 1.06% |
| MARIA C GONZALEZ3 Filed as: MARIA C. GONZALEZ | 11677 SANDPIPER COURT MORENO VALLEY, CA 92557 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $86 | $4 | $90 | 0.75% |
| LIFE TIME SOLUTIONS LLC3 | 861 KENWOOD STREET UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $69 | $12 | $81 | 0.67% |
| CENTENNIAL GROUP BENEFITS INSURANCE3 | P.O. BOX 26457 SANTA ANA, CA 92799 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 15.00% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $463 | $463 | 4.00% |
| CENTENNIAL GROUP BENEFITS INSURANCE3 | P.O. BOX 26457 SANTA ANA, CA 92799 | UDC DENTAL OF CALIFORNIA, INC. | $1K | — | $1K | 10.05% |
| CENTENNIAL GROUP BENEFITS INSURANCE3 | P.O. BOX 26457 SANTA ANA, CA 92799 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $349 | — | $349 | 14.98% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $93 | $93 | 3.99% |
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 | 262 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 264 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 201 | $2.4M |
| Dental(2 contracts, 2 carriers) | UNION SECURITY INSURANCE COMPANY | 173 | $267K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 173 | $23K |
| Life insurance(2 contracts, 2 carriers) | UNION SECURITY INSURANCE COMPANY | 262 | $268K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 261 | $80K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 201 | $2.4M |
| Other(4 contracts, 4 carriers) | UNION SECURITY INSURANCE COMPANY | 262 | $312K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 262 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.