| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BURNHAM BENEFITS INSURANCE SERVICES3 Filed as: BURHAM BENEFITS INSURANCE SERVICES | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | ANTHEM BLUE CROSS | $18K | — | $18K | 1.84% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $778 | $3K | 2.72% |
| VITAL SIGNS INSURANCE SERVICES INC.3 Filed as: VITAL SIGNS INSURANCE SERVICES | PO BOX 6360 FOLSOM, CA 95763 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $279 | — | $279 | 0.26% |
| BURNHAM BENEFITS INSURANCE SERVICES3 Filed as: BURHAM BENEFITS INSURANCE SERVICES | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 1.48% |
| VITAL SIGNS INSURANCE SERVICES INC.3 Filed as: VITAL SIGNS INSURANCE SERVICES, INC | 950 GLENN DRIVE, SUITE 100 FOLSON, CA 95630 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $15 | — | $15 | 0.02% |
| BURNHAM BENEFITS INSURANCE SERVICES3 | 2211 MICHELSON DRIVE, SUITE 1200 IRVINE, CA 92612 | VISION SERVICE PLAN | $460 | — | $460 | 1.44% |
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 | 170 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 170 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM BLUE CROSS | 159 | $959K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 159 | $88K |
| Vision | VISION SERVICE PLAN | 159 | $32K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 170 | $106K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 170 | $106K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 170 | $106K |
| Prescription drug | ANTHEM BLUE CROSS | 159 | $959K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 170 | $106K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 170 | — |
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.