Form 5500 · Employee benefit plan · CLEVELAND, OK
CLEVELAND INTEGRITY SERVICES, LLC
The filing calls this plan CLEVELAND INTEGRITY SERVICES, LLC HEALTH & WELFARE PLAN.
CLEVELAND INTEGRITY SERVICES, LLC of CLEVELAND, OK insures health, dental, vision, life and disability coverage for its employees, per Schedule A of its Form 5500. Its broker of record is AON RISK SERVICES INC OF FLORIDA. Coverage is written through BLUECROSS BLUESHIELD OF OKLAHOMA and 2 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 92-2109568 · plan 501 · plan year 2024, filed Jul 8, 2025
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Health: BLUECROSS BLUESHIELD OF OKLAHOMA covers 24 of 243 participants (9.9%) on Schedule A.
Dental: BLUECROSS BLUESHIELD OF OKLAHOMA covers 24 of 243 participants (9.9%) on Schedule A.
Also declared: death benefits, other welfare.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 3 insured contracts covering health, dental, vision, life and disability.
Reported premium across the insured contracts is $269,106, with $10,320 in disclosed broker commissions — about 3.8% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
AON RISK SERVICES INC OF FLORIDA is the broker of record on 1 of the 3 contracts; the rest name a different broker or none.
3 carriers appear on the filing, including BLUECROSS BLUESHIELD OF OKLAHOMA, RELIASTAR LIFE INSURANCE COMPANY and EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO.. BLUECROSS BLUESHIELD OF OKLAHOMA writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUECROSS BLUESHIELD OF OKLAHOMA | Health, Dental | 24 | Jan 1, 2025 | $242,016 | $5,689 |
| RELIASTAR LIFE INSURANCE COMPANY | Life, Disability | 28 | Jan 1, 2025 | $14,548 | $3,213 |
| EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | Vision | 34 | Jan 1, 2025 | $12,542 | $1,418 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Other plans filed by this employer
How this plan compares
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