| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INTEGRITY ASSOCIATES INS. SERVICES3 Filed as: INTEGRITY ASSOCIATES | P.O. BOX 1006 THOUSAND OAKS, CA 91358 | CIGNA HEALTH & LIFE INSURANCE CO. | $102K | — | $102K | 6.85% |
| INTEGRITY ASSOCIATES INS. SERVICES3 Filed as: INTEGRITY ASSOCIATES | P.O. BOX 1006 THOUSAND OAKS, CA 91358 | DELTA DENTAL OF CALIFORNIA | $38K | — | $38K | 3.00% |
| INTEGRITY ASSOCIATES INS. SERVICES3 | P.O. BOX 1006 THOUSAND OAKS, CA 91358 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $31K | — | $31K | 10.00% |
| INTEGRITY ASSOCIATES INS. SERVICES3 | P.O. BOX 1006 THOUSAND OAKS, CA 91358 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $32K | — | $32K | 15.00% |
| INTEGRITY ASSOCIATES INS. SERVICES3 Filed as: INTEGRITY ASSOCIATES INSURANCE | P.O. BOX 1006 THOUSAND OAKS, CA 91358 | VISION SERVICE PLAN | $18K | — | $18K | 9.99% |
| INTEGRITY ASSOCIATES INS. SERVICES3 Filed as: INTEGRITY ASSOCIATES INSURANCE | P.O. BOX 1006 THOUSAND OAKS, CA 91358 | VISION SERVICE PLAN | $15K | — | $15K | 9.99% |
| INTEGRITY ASSOCIATES INS. SERVICES3 | P.O. BOX 1006 THOUSAND OAKS, CA 91358 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $8K | — | $8K | 5.00% |
| INTEGRITY ASSOCIATES INS. SERVICES3 | P.O. BOX 1006 THOUSAND OAKS, CA 91358 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $16K | — | $16K | 15.00% |
| INTEGRITY ASSOCIATES INS. SERVICES3 | P.O. BOX THOUSAND OAKS, CA 91358 | LINCOLN NATIONAL LIFE INSURANCE CO. | $1K | — | $1K | 5.00% |
| USI INSURANCE SERVICES LLC3 | 2375 E. CAMELBACK RD. #250 PHOENIX, AZ 85016 | FEDERAL INSURANCE COMPANY | $34 | — | $34 | 1.05% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH & LIFE INSURANCE CO. EIN 59-1031071 CONTRACT ADMINISTRATOR | Non-monetary compensation; Other services; Float revenue; Participant communication; Contract Administrator; Direct payment from the plan; Named fiduciary; Claims processing Service code 12 | — | $926K |
| EVERNORTH BEHAVIORAL HEALTH, INC. EIN 41-1648670 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing; Participant communication; Direct payment from the plan Service code 12 | — | $14K |
| CIGNA HEALTH AND LIFE INSURANCE CO. | Float revenue; Non-monetary compensation; Direct payment from the plan; Named fiduciary; Participant communication; Contract Administrator; Other services; Claims processing Service code 12 | — | $0 |
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 | 663 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 12 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 675 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH & LIFE INSURANCE CO. | 675 | $1.5M |
| Dental | DELTA DENTAL OF CALIFORNIA | 673 | $1.3M |
| Vision(2 contracts) | VISION SERVICE PLAN | 344 | $336K |
| Life insurance(3 contracts, 2 carriers) | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 650 | $481K |
| Short-term disability | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 650 | $110K |
| Long-term disability | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 650 | $213K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH & LIFE INSURANCE CO. | 675 | $1.5M |
| Other(3 contracts, 3 carriers) | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 650 | $333K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 675 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.