Form 5500 · Employee benefit plan · HAWTHORNE, CA
SOUTH BAY FORD
SOUTH BAY FORD of HAWTHORNE, CA files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is VARIOUS - SEE ATTACHED. Coverage is written through CALIFORNIA PHYSICIANS' SERVICE (BLUE SHIELD OF CALIFORNIA) and 2 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 95-4451497 · plan 501 · as of Aug 2026
Plan brief
Schedule A lists 3 insured contracts covering health, dental, vision and life; the largest, with CALIFORNIA PHYSICIANS' SERVICE (BLUE SHIELD OF CALIFORNIA), covers 171 people.
Reported premium across the insured contracts is $1,536,088, with $22,632 in disclosed broker commissions — about 1.5% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
VARIOUS - SEE ATTACHED is the broker of record on 1 of the 3 contracts; the rest name a different broker or none.
3 carriers appear on the filing — CALIFORNIA PHYSICIANS' SERVICE (BLUE SHIELD OF CALIFORNIA), AFLAC and BLUE SHIELD OF CALIFORNIA LIFE & HEALTH INSURANCE COMPANY — with CALIFORNIA PHYSICIANS' SERVICE (BLUE SHIELD OF CALIFORNIA) writing the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| AFLAC | — | 55 | December | $60,178 | $12,592 |
| CALIFORNIA PHYSICIANS' SERVICE (BLUE SHIELD OF CALIFORNIA) | Health, Dental, Vision | 171 | December | $1,460,420 | $8,491 |
| BLUE SHIELD OF CALIFORNIA LIFE & HEALTH INSURANCE COMPANY | Life | 196 | December | $15,490 | $1,549 |
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