| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INTEGRATED BENEFITS & INS SERV INC3 | 1831 IRON POINT ROAD #100 FOLSOM, CA 95630 | KAISER FOUNDATION HEALTH PLAN INC | $125K | $0 | $125K | 4.17% |
| INTEGRATED BENEFITS & INS SERV INC3 | 1831 IRON POINT ROAD #100 FOLSOM, CA 95630 | WESTERN HEALTH ADVANTAGE | $109K | $0 | $109K | 4.00% |
| AMWINS3 Filed as: LISI | 1600 W HILLSDALE BLVD SAN MATEO, CA 94402 | BLUE SHIELD OF CALIFORNIA | $10K | $0 | $10K | 2.00% |
| INTEGRATED BENEFITS & INS SERV INC3 | 1831 IRON POINT ROAD #100 FOLSOM, CA 95630 | BLUE SHIELD OF CALIFORNIA | $2K | $0 | $2K | 0.40% |
| INTEGRATED BENEFITS & INS SERV INC3 | 1831 IRON POINT ROAD #100 FOLSOM, CA 95630 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $10K | $0 | $10K | 2.28% |
| INTEGRATED BENEFITS & INS SERV INC3 | 1831 IRON POINT ROAD #100 FOLSOM, CA 95630 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | $0 | $3K | 11.11% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| INTEGRATED BENEFITS & INS SERV INC EIN 94-2850278 BROKER | Insurance agents and brokers Service code 22 | 1831 IRON POINT ROAD #100 FOLSOM, CA 95630 | $0 |
| LISI EIN 94-2757978 GENERAL AGENT | Insurance agents and brokers Service code 22 | 1600 W HILLSDALE BLVD SAN MATEO, CA 94402 | $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 | 867 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 21 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 890 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 504 | $6.2M |
| Dental | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 505 | $437K |
| Life insurance | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 867 | $23K |
| Long-term disability | KAISER FOUNDATION HEALTH PLAN INC | 504 | $3.0M |
| Prescription drug(2 contracts, 2 carriers) | WESTERN HEALTH ADVANTAGE | 299 | $3.2M |
| Other | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 867 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 867 | — |
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."
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.