| 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. | $97K | — | $97K | 7.58% |
| INTEGRITY ASSOCIATES INS. SERVICES3 Filed as: INTEGRITY ASSOCIATES | P.O. BOX 1006 THOUSAND OAKS, CA 91358 | DELTA DENTAL OF CALIFORNIA | $37K | — | $37K | 3.00% |
| INTEGRITY ASSOCIATES INS. SERVICES3 | P.O. BOX 1006 THOUSAND OAKS, CA 91358 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $29K | — | $29K | 10.00% |
| INTEGRITY ASSOCIATES INS. SERVICES3 | P.O. BOX 1006 THOUSAND OAKS, CA 91358 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $30K | — | $30K | 15.00% |
| INTEGRITY ASSOCIATES INS. SERVICES3 Filed as: INTEGRITY ASSOCIATES INSURANCE | P.O. BOX 1006 THOUSAND OAKS, CA 91358 | VISION SERVICE PLAN | $20K | — | $20K | 11.36% |
| INTEGRITY ASSOCIATES INS. SERVICES3 Filed as: INTEGRITY ASSOCIATES INSURANCE | P.O. BOX 1006 THOUSAND OAKS, CA 91358 | VISION SERVICE PLAN | $14K | — | $14K | 10.00% |
| INTEGRITY ASSOCIATES INS. SERVICES3 | P.O. BOX 1006 THOUSAND OAKS, CA 91358 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $7K | — | $7K | 5.00% |
| INTEGRITY ASSOCIATES INS. SERVICES3 | P.O. BOX 1006 THOUSAND OAKS, CA 91358 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $15K | — | $15K | 15.00% |
| INTEGRITY ASSOCIATES INS. SERVICES3 | P.O. BOX THOUSAND OAKS, CA 91358 | LINCOLN NATIONAL LIFE INSURANCE CO. | $1K | — | $1K | 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; Contract Administrator; Direct payment from the plan; Float revenue; Non-monetary compensation; Claims processing; Participant communication; Other services Service code 12 | — | $646K |
| EVERNORTH BEHAVIORAL HEALTH, INC. EIN 41-1648670 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing; Direct payment from the plan; Participant communication Service code 12 | — | $13K |
| CIGNA HEALTH AND LIFE INSURANCE CO. | Other services; Float revenue; Direct payment from the plan; Contract Administrator; Participant communication; Named fiduciary; Claims processing; Non-monetary compensation 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 | 626 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 635 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH & LIFE INSURANCE CO. | 635 | $1.3M |
| Dental | DELTA DENTAL OF CALIFORNIA | 627 | $1.2M |
| Vision(2 contracts) | VISION SERVICE PLAN | 338 | $324K |
| Life insurance(3 contracts, 2 carriers) | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 615 | $442K |
| Short-term disability | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 615 | $102K |
| Long-term disability | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 615 | $198K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH & LIFE INSURANCE CO. | 635 | $1.3M |
| Other(3 contracts, 3 carriers) | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 615 | $312K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 635 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.