| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CENTENNIAL GROUP BENEFITS INSURANCE3 Filed as: CENTENNIAL GROUP BENEFITS AND | INSURANCE SERVICES, INC. 1800 QUAIL ST, SUITE 110 NEWPORT BEACH, CA 926602340 | CALIFORNIA PHYSICIANS SERVICE (BLUE SHIELD OF CALIFORNIA) | $0 | $188K | $188K | 2.86% |
| ACRISURE LLC3 Filed as: ORION RISK MANAGEMENT INSURANCE | — | BLUE CROSS BLUE SHIELD OF TEXAS | $47K | $0 | $47K | 4.62% |
| BCI INSURANCE SOLUTIONS, INC.3 | — | BLUE CROSS BLUE SHIELD OF TEXAS | $0 | $7K | $7K | 0.64% |
| CENTENNIAL GROUP BENEFITS INSURANCE3 Filed as: CENTENNIAL GROUP BENEFITS AND | INSURANCE SERVICES, INC. 1800 QUAIL ST, SUITE 110 NEWPORT BEACH, CA 926602340 | PRINCIPAL LIFE INSURANCE COMPANY | $49K | $0 | $49K | 10.00% |
| GCG FINANCIAL LLC3 Filed as: ALERA GROUP | 965 GREENTREE RD SUITE 110 PITTSBURGH, PA 152203353 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $6K | $6K | 1.26% |
| CENTENNIAL GROUP BENEFITS INSURANCE3 Filed as: CENTENNIAL GROUP BENEFITS AND | INSURANCE SERVICES, INC. PO BOX 26457 SANTA ANA, CA 92799 | NEW YORK LIFE (LIFE INSURANCE COMPANY OF NORTH AMERICA) | $18K | $0 | $18K | 10.32% |
| GCG FINANCIAL LLC3 Filed as: ALERA GROUP | 3 PARKWAY NORTH SUITE 500 DEERFIELD, IL 60015 | NEW YORK LIFE (LIFE INSURANCE COMPANY OF NORTH AMERICA) | $0 | $4K | $4K | 2.01% |
| NATIONAL BENEFIT CENTER3 | 3700 PARK E DRIVE SUITE 350 BEACHWOOD, OH 44122 | NEW YORK LIFE (LIFE INSURANCE COMPANY OF NORTH AMERICA) | $0 | $99 | $99 | 0.06% |
| SEE ATTACHED3 | COLONIAL LIFE AND ACCIDENT INS CO PO BOX 1365 COLUMBIA, SC 292021365 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $9K | $371 | $10K | 12.00% |
| CENTENNIAL GROUP BENEFITS INSURANCE3 Filed as: CENTENNIAL GROUP BENEFITS AND | INSURANCE SERVICES, INC. PO BOX 26457 SANTA ANA, CA 92799 | NEW YORK LIFE (LIFE INSURANCE COMPANY OF NORTH AMERICA) | $5K | $0 | $5K | 14.82% |
| CENTENNIAL GROUP BENEFITS INSURANCE3 Filed as: CENTENNIAL GROUP BENEFITS AND | INSURANCE SERVICES, INC. PO BOX 26457 SANTA ANA, CA 92799 | NEW YORK LIFE (LIFE INSURANCE COMPANY OF NORTH AMERICA) | $3K | $0 | $3K | 10.20% |
| GCG FINANCIAL LLC3 Filed as: ALERA GROUP | 3 PARKWAY NORTH SUITE 500 DEERFIELD, IL 60015 | NEW YORK LIFE (LIFE INSURANCE COMPANY OF NORTH AMERICA) | $0 | $544 | $544 | 2.08% |
| NATIONAL BENEFIT CENTER3 | 3700 PARK E DRIVE SUITE 350 BEACHWOOD, OH 44122 | NEW YORK LIFE (LIFE INSURANCE COMPANY OF NORTH AMERICA) | $0 | -$10 | -$10 | -0.04% |
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 | 864 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 868 | 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) | 623 | $7.6M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 663 | $493K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 663 | $493K |
| Life insurance(2 contracts, 2 carriers) | NEW YORK LIFE (LIFE INSURANCE COMPANY OF NORTH AMERICA) | 864 | $258K |
| Long-term disability | NEW YORK LIFE (LIFE INSURANCE COMPANY OF NORTH AMERICA) | 8 | $33K |
| Prescription drug(2 contracts, 2 carriers) | CALIFORNIA PHYSICIANS SERVICE (BLUE SHIELD OF CALIFORNIA) | 623 | $7.6M |
| Other(2 contracts, 2 carriers) | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 864 | $107K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 864 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.