| 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 | DELTA DENTAL OF CALIFORNIA | $28K | — | $28K | 3.00% |
| INTEGRITY ASSOCIATES INS. SERVICES3 Filed as: INTEGRITY ASSOCIATES | P.O. BOX 1006 THOUSAND OAKS, CA 91358 | CIGNA HEALTH & LIFE INSURANCE CO. | $103K | — | $103K | 12.10% |
| INTEGRITY ASSOCIATES INS. SERVICES3 Filed as: INTEGRITY ASSOCIATES INSURANCE | P.O. BOX 1006 THOUSAND OAKS, CA 91358 | VISION SERVICE PLAN | $25K | — | $25K | 10.00% |
| INTEGRITY ASSOCIATES INS. SERVICES3 | P.O. BOX 1006 THOUSAND OAKS, CA 91358 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $20K | — | $20K | 10.00% |
| INTEGRITY ASSOCIATES INS. SERVICES3 | P.O. BOX 1006 THOUSAND OAKS, CA 91358 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $20K | — | $20K | 15.00% |
| INTEGRITY ASSOCIATES INS. SERVICES3 | P.O. BOX 1006 THOUSAND OAKS, CA 91358 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $11K | — | $11K | 15.00% |
| INTEGRITY ASSOCIATES INS. SERVICES3 | P.O. BOX 1006 THOUSAND OAKS, CA 91358 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | — | $3K | 5.00% |
| INTEGRITY ASSOCIATES INS. SERVICES3 | P.O. BOX THOUSAND OAKS, CA 91358 | LINCOLN NATIONAL LIFE INSURANCE CO. | $627 | — | $627 | 5.00% |
| HAYS COMPANIES, INC.3 Filed as: HAYS COMPANIES INC. | 1350 BAYSHORE HWY #218 BURLINGAME, CA 94010 | FEDERAL INSURANCE COMPANY | $570 | — | $570 | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH & LIFE INSURANCE CO. EIN 59-1031071 CONTRACT ADMINISTRATOR | Named fiduciary; Other services; Contract Administrator; Participant communication; Float revenue; Non-monetary compensation; Direct payment from the plan; Claims processing Service code 12 | — | $688K |
| CIGNA BEHAVIORAL HEALTH, INC. EIN 41-1648670 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator; Participant communication; Direct payment from the plan Service code 12 | — | $10K |
| CIGNA HEALTH AND LIFE INSURANCE CO. | Direct payment from the plan; Named fiduciary; Participant communication; Other services; Non-monetary compensation; Claims processing; Float revenue; Contract Administrator Service code 12 | — | $1K |
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 | 481 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 11 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 492 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH & LIFE INSURANCE CO. | 492 | $847K |
| Dental | DELTA DENTAL OF CALIFORNIA | 485 | $936K |
| Vision | VISION SERVICE PLAN | 485 | $249K |
| Life insurance(3 contracts, 2 carriers) | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 466 | $275K |
| Short-term disability | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 466 | $73K |
| Long-term disability | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 466 | $133K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH & LIFE INSURANCE CO. | 492 | $847K |
| Other(3 contracts, 3 carriers) | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 466 | $213K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 492 | — |
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.