| 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 | $36K | — | $36K | 3.00% |
| INTEGRITY ASSOCIATES INS. SERVICES3 Filed as: INTEGRITY ASSOCIATES | P.O. BOX 1006 THOUSAND OAKS, CA 91358 | CIGNA HEALTH & LIFE INSURANCE CO. | $90K | — | $90K | 8.61% |
| INTEGRITY ASSOCIATES INS. SERVICES3 Filed as: INTEGRITY ASSOCIATES INSURANCE | P.O. BOX 1006 THOUSAND OAKS, CA 91358 | VISION SERVICE PLAN | $29K | — | $29K | 10.00% |
| INTEGRITY ASSOCIATES INS. SERVICES3 | P.O. BOX 1006 THOUSAND OAKS, CA 91358 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $22K | — | $22K | 10.00% |
| INTEGRITY ASSOCIATES INS. SERVICES3 | P.O. BOX 1006 THOUSAND OAKS, CA 91358 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $23K | — | $23K | 15.00% |
| INTEGRITY ASSOCIATES INS. SERVICES3 | P.O. BOX 1006 THOUSAND OAKS, CA 91358 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $5K | — | $5K | 5.00% |
| INTEGRITY ASSOCIATES INS. SERVICES3 | P.O. BOX 1006 THOUSAND OAKS, CA 91358 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $12K | — | $12K | 15.00% |
| INTEGRITY ASSOCIATES INS. SERVICES3 | P.O. BOX THOUSAND OAKS, CA 91358 | LINCOLN NATIONAL LIFE INSURANCE CO. | $884 | — | $884 | 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 | Participant communication; Float revenue; Claims processing; Non-monetary compensation; Contract Administrator; Named fiduciary; Other services; Direct payment from the plan Service code 12 | — | $554K |
| CIGNA BEHAVIORAL HEALTH, INC. EIN 41-1648670 CONTRACT ADMINISTRATOR | Direct payment from the plan; Contract Administrator; Participant communication; Claims processing Service code 12 | — | $12K |
| CIGNA HEALTH AND LIFE INSURANCE CO. | Non-monetary compensation; Contract Administrator; Float revenue; Claims processing; Named fiduciary; Direct payment from the plan; Participant communication; Other services 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 | 566 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 572 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH & LIFE INSURANCE CO. | 572 | $1.0M |
| Dental | DELTA DENTAL OF CALIFORNIA | 570 | $1.2M |
| Vision | VISION SERVICE PLAN | 573 | $290K |
| Life insurance(3 contracts, 2 carriers) | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 587 | $340K |
| Short-term disability | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 562 | $80K |
| Long-term disability | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 562 | $151K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH & LIFE INSURANCE CO. | 572 | $1.0M |
| Other(3 contracts, 3 carriers) | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 569 | $243K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 587 | — |
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.