| 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. | $48K | — | $48K | 4.55% |
| CENTENNIAL GROUP BENEFITS3 | P.O. BOX 26457 SANTA ANA, CA 92799 | PRINCIPAL LIFE INSURANCE COMPANY | $4K | — | $4K | 6.50% |
| CENTENNIAL GROUP BENEFITS3 | 1500 QUAIL ST. STE 100 NEWPORT BEACH, CA 92660 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 10.00% |
| CENTENNIAL GROUP BENEFITS3 | P.O. BOX 26457 SANTA ANA, CA 92799 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $605 | — | $605 | 4.57% |
| BENEFIT ADVISORS NETWORK LLC3 Filed as: BENEFIT ADVISORS NETWORK | 6830 COCHRAN ROAD SOLON, OH 44139 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $19 | $19 | 0.14% |
| CENTENNIAL GROUP BENEFITS3 | P.O. BOX 3387 SEAL BEACH, CA 90740 | GOLDEN WEST HEALTH PLAN, INC. | $1K | — | $1K | 10.27% |
| PARKER E. LYONS3 | 2021 BUSINESS CENTER DRIVE, STE 205 IRVINE, CA 92612 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $721 | — | $721 | 14.99% |
| CENTENNIAL GROUP BENEFITS3 | P.O. BOX 26457 SANTA ANA, CA 92799 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $166 | — | $166 | 3.75% |
| CENTENNIAL GROUP BENEFITS3 | 1500 QUAIL ST. STE 100 NEWPORT BEACH, CA 92660 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $134 | — | $134 | 10.03% |
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 | 220 | 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) | 222 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 165 | $1.1M |
| Dental(2 contracts, 2 carriers) | PRINCIPAL LIFE INSURANCE COMPANY | 98 | $75K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 98 | $63K |
| Life insurance(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 220 | $6K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 16 | $13K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 220 | $18K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 165 | $1.1M |
| Other(5 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 220 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 220 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.