Form 5500 · Employee benefit plan · CAMARILLO, CA
GOLDEN STATE MEDICAL SUPPLY, INC.
The filing calls this plan GOLDEN STATE MEDICAL SUPPLY WELFARE BENEFITS PLAN.
GOLDEN STATE MEDICAL SUPPLY, INC. of CAMARILLO, CA is a 201-participant wholesale trade employer whose group benefits are disclosed in its annual Form 5500 filing. Its broker of record is ADVOCATE NAVA BENEFITS. Coverage is written through BLUE CROSS OF CALIFORNIA and 3 other carriers. The plan's most recent policy period ended in May.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 95-4226167 · plan 501 · plan year 2025, filed Feb 4, 2026
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Also declared: prepaid legal, death benefits, other welfare.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 4 insured contracts covering health, dental, vision, life and disability; the largest, with BLUE CROSS OF CALIFORNIA, covers 375 people.
Reported premium across the insured contracts is $3,497,636, with $135,185 in disclosed broker commissions — about 3.9% of premium.
The health contract's policy period ended in May, while at least one ancillary line's policy period ended in August. The plan is on a split renewal cycle.
ADVOCATE NAVA BENEFITS is the broker of record on 1 of the 4 contracts; the rest name a different broker or none.
4 carriers appear on the filing, including BLUE CROSS OF CALIFORNIA, ANTHEM LIFE INSURANCE COMPANY, METROPOLITAN GENERAL INSURANCE COMPANY and METLIFE LEGAL PLANS. BLUE CROSS OF CALIFORNIA writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUE CROSS OF CALIFORNIA | Health, Dental, Vision | 375 | Jun 1, 2025 | $2,437,628 | $128,627 |
| ANTHEM LIFE INSURANCE COMPANY | Life, Disability | 9,920 | Jun 1, 2025 | $1,053,726 | $6,015 |
| METROPOLITAN GENERAL INSURANCE COMPANY | — | 21 | Jun 1, 2025 | $5,634 | $446 |
| METLIFE LEGAL PLANS | — | 12 | Sep 1, 2024 | $648 | $97 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Reported to OSHA
Reported to OSHA for 2025: 211 employees, 4 recordable cases, 2 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
How this plan compares
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