| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INTEGRO INSURANCE BROKERS3 | 3500 LENOX ROAD, SUITE 1600 ATLANTA, GA 30326 | BLUE CROSS OF CALIFORNIA | $158K | — | $158K | 4.30% |
| INTEGRO INSURANCE BROKERS3 | 3620 BIRCH STREET NEWPORT BEACH, CA 92660 | KAISER FOUNDATION HEALTH PLAN INC. | $113K | — | $113K | 3.45% |
| INTEGRO INSURANCE BROKERS3 | 3620 BIRCH STREET NEWPORT BEACH, CA 92660 | METROPOLITAN LIFE INSURANCE COMPANY | $38K | $9K | $48K | 6.79% |
| INTEGRO INSURANCE BROKERS3 | 3620 BIRCH STREET NEWPORT BEACH, CA 92660 | KAISER FOUNDATION HEALTH PLAN OF COLORADO | $23K | $3K | $26K | 4.48% |
| INTEGRO INSURANCE BROKERS3 | 3620 BIRCH STREET NEWPORT BEACH, CA 92660 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $55K | $2K | $57K | 15.49% |
| INTEGRO INSURANCE BROKERS3 | 3620 BIRCH STREET, 1ST FLOOR NEWPORT, CA 92660 | EYEMED VISION CARE | $6K | — | $6K | 7.45% |
| INTEGRO INSURANCE BROKERS | — | SAFEGUARD HEALTH PLANS, INC. | $3K | $731 | $3K | 6.79% |
| INTEGRO INSURANCE BROKERS3 | — | KAISER FOUNDATION HEALTH PLAN INC. | $2K | — | $2K | 3.41% |
| INTEGRO INSURANCE BROKERS3 | 3620 BIRCH STREET NEWPORT BEACH, CA 92660 | UNITED DENTAL CARE OF COLORADO, INC. | $2K | — | $2K | 10.00% |
No Schedule C service providers reported on this filing.
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 | 1,063 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,065 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(6 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 2,026 | $8.2M |
| Dental(3 contracts, 3 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 1,709 | $771K |
| Vision | EYEMED VISION CARE | 2,966 | $81K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,043 | $368K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,043 | $368K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,043 | $368K |
| Prescription drug(6 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 2,026 | $8.2M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,043 | $368K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,966 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.