| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LBL INSURANCE SERVICES INC3 | 3631 S HARBOR BLVD SUITE 200 SANTA ANA, CA 90720 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $360K | — | $360K | 1.05% |
| LBL INSURANCE SERVICES INC3 Filed as: LBL INSURANCE SERVICES, INC. | 3631 S. HARBOR BLVD #200 SANTA ANA, CA 92704 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $0 | $14K | $14K | 0.79% |
| LBL INSURANCE SERVICES INC3 | 3631 S HARBOR BLVD SUITE 200 SANTA ANA, CA 92704 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | — | $9K | $9K | 2.24% |
| LBL INSURANCE SERVICES INC3 Filed as: LBL INSURANCE SERVICES, INC. | 3631 S HARBOR BLVD SUITE 200 SANTA ANA, CA 92704 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $0 | $8K | $8K | 2.97% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM BLUE CROSS EIN 95-4331852 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator; Other services; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $1.4M |
| VITA ADMINISTRATION COMPANY EIN 95-1643381 SERVICE PROVIDER | Direct payment from the plan; Contract Administrator; Account maintenance fees Service code 13 | — | $219K |
| REACH EMPLOYEE ASSISTANCE, INC. EIN 33-0844014 SERVICE PROVIDER | Account maintenance fees; Claims processing; Direct payment from the plan Service code 12 | — | $144K |
| BLUE CROSS OF CALIFORNIA EIN 95-3760980 CONTRACT ADMINISTRATOR | Other services; Claims processing; Contract Administrator; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $9K |
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 | 8,448 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 211 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 324 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 8,983 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 5,576 | $34.2M |
| Dental(2 contracts) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 7,152 | $675K |
| Vision | VISION SERVICE PLAN | 8,682 | $824K |
| Life insurance | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 8,448 | $1.7M |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 8,448 | $1.7M |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 8,448 | $1.7M |
| Prescription drug | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 5,576 | $34.2M |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 8,448 | $2.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 8,682 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.