| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CENTENNIAL GROUP BENEFITS3 | P.O. BOX 26457 SANTA ANA, CA 92799 | BLUE CROSS OF CALIFORNIA | $78K | — | $78K | 5.84% |
| CENTENNIAL GROUP BENEFITS INSURANCE3 | P.O. BOX 26457 SANTA ANA, CA 92799 | KAISER FOUNDATION HEALTH PLAN INC. | $50K | — | $50K | 4.76% |
| CENTENNIAL GROUP BENEFITS3 | P.O. BOX 26457 SANTA ANA, CA 92799 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $14K | — | $14K | 5.26% |
| PACIFIC ADVISOR LLC3 | 333 INDIAN HILL BLVD. CLAREMONT, CA 91711 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 0.39% |
| 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 BENEFITS3 | 1500 QUAIL STREET, SUITE 100 NEWPORT BEACH, CA 92660 | ORRIANT, LLC | $1K | — | $1K | 2.83% |
| CENTENNIAL GROUP BENEFITS INSURANCE3 | PO BOX 26457 SANTA ANA, CA 92799 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $3K | — | $3K | 10.00% |
| 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 | — | $547 | $547 | 4.00% |
| CENTENNIAL GROUP BENEFITS3 | P.O. BOX 26457 SANTA ANA, CA 92799 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1K | $41 | $1K | 11.29% |
| JOHN D EVANGELISTA3 Filed as: JOHN D. EVANGELISTA | 26111 ANTONIO PARKWAY RANCHO SANTA MARGARITA, SC 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $850 | $288 | $1K | 9.12% |
| BENEFITS COORDINATOR3 | 10741 LA JARA STREET CERRITOS, CA 90703 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $640 | $228 | $868 | 6.96% |
| STEPHEN W DOUGLASS3 Filed as: STEPHEN W. DOUGLAS | 45 MORNING GLORY RANCHO SANTA MARGARITA, CA 92688 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $68 | — | $68 | 0.55% |
| ALEXANDER OTTONIEL CANAS3 | 26123 BOUQUET CANYON ROAD SANTA CLARITA, CA 91350 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $48 | — | $48 | 0.38% |
| MARIA C GONZALEZ3 Filed as: MARIA C. GONZALEZ | 11677 SANDPIPER COURT MORENO VALLEY, CA 92557 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $48 | — | $48 | 0.38% |
| RAYMOND KWOCKMAN GONG3 | 2180 FENTON PARKWAY SAN DIEGO, CA 92108 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | $2 | $18 | 0.14% |
| LIFE TIME SOLUTIONS LLC3 | 861 KENWOOD STREET UPLAND, CA 91784 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | $2 | $12 | 0.10% |
| CLIENT BENEFIT INSURANCE SERVICES3 | 5675 RUFFIN ROAD SAN DIEGO, CA 92123 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | — | $2 | 0.02% |
| CENTENNIAL GROUP BENEFITS INSURANCE3 | P.O. BOX 26457 SANTA ANA, CA 92799 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $413 | — | $413 | 15.02% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $110 | $110 | 4.00% |
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 | 259 | 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) | 261 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 212 | $2.4M |
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 238 | $271K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 182 | $25K |
| Life insurance(2 contracts, 2 carriers) | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 258 | $284K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 259 | $81K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 212 | $2.4M |
| Other(4 contracts, 4 carriers) | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 258 | $331K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 259 | — |
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.