Form 5500 · Employee benefit plan · ORANGE, CA
SOUTHERN COUNTIES LUBRICANTS, LLC
The filing calls this plan SOUTHERN COUNTIES LUBRICANTS WELFARE BENEFIT PLAN.
SOUTHERN COUNTIES LUBRICANTS, LLC of ORANGE, CA insures health, dental, vision, life and disability coverage for its employees, per Schedule A of its Form 5500. Its broker of record is INSURANCE OFFICE OF AMERICA, INC.. Coverage is written through ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY and 1 other carrier. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 91-1874721 · plan 501 · plan year 2025, filed Jun 23, 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.
The filing carries code 4S: this plan is filing again after previously being exempt.
Benefits declared on this filing
Also declared: death benefits.
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.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
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 ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY, covers 230 people.
Reported premium across the insured contracts is $1,697,203, with $106,349 in disclosed broker commissions — about 6.3% 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.
INSURANCE OFFICE OF AMERICA, INC. is the broker of record on 1 of the 4 contracts; the rest name a different broker or none.
Two carriers split the book: ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY and STANDARD INSURANCE COMPANY.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | Health, Dental, Vision | 230 | Jan 1, 2026 | $1,596,268 | $92,275 |
| STANDARD INSURANCE COMPANY | Life | 139 | Jan 1, 2026 | $63,945 | $8,947 |
| STANDARD INSURANCE COMPANY | Disability | 139 | Jan 1, 2026 | $32,576 | $4,516 |
| STANDARD INSURANCE COMPANY | Disability | 139 | Jan 1, 2026 | $4,414 | $611 |
Premium and claims on these contracts
STANDARD INSURANCE COMPANY, contract 763505. For the contract year on this filing, the carrier reported $63,945 in premium earned and $10,822 in claims incurred. Dividing one by the other gives 17%.
STANDARD INSURANCE COMPANY, contract 763505. For the contract year on this filing, the carrier reported $32,576 in premium earned and $59,113 in claims incurred. Dividing one by the other gives 181%.
- STANDARD INSURANCE COMPANY, contract 763505 reported $55,451 in retention.
- STANDARD INSURANCE COMPANY, contract 763505 reported $22,964 in retention.
Retention is what the carrier kept of the premium after claims, as reported: administration, commissions and other charges.
Only experience-rated contracts report these figures, so most filings leave them blank.
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.
Other plans filed by this employer
How this plan compares
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