| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 W MACARTHUR BLVD., STE 320 SANTA ANA, CA 92704 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $132K | — | $132K | 2.27% |
| EMERSON REID LLC3 Filed as: EMERSON REID & COMPANY | 669 RIVER DR. #202 ELMWOOD PARK, NJ 07407 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | — | $17K | $17K | 0.28% |
| CLEVIDENCE INSURANCE SERVICES INC3 | 3000 W MACARTHUR BLVD., STE 320 SANTA ANA, CA 92704 | AETNA LIFE INSURANCE COMPANY | $10K | — | $10K | 2.00% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 W MACARTHUR BLVD., STE 320 SANTA ANA, CA 927047907 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $21K | $21K | 4.54% |
| MODEL CONSULTING INC3 Filed as: MODEL CONSULTING INC. | 3160 TREMONT AVE TREVOSE, PA 190536644 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $5K | $5K | 0.97% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES INC. | 3000 W MACARTHUR BLVD., STE 320 SANTA ANA, CA 927047907 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $16K | $16K | 5.34% |
| MODEL CONSULTING INC3 | 3160 TREMONT AVE TREVOSE, PA 190536644 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $3K | $3K | 0.88% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 W MACARTHUR BLVD., STE 320 SANTA ANA, CA 927047907 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $13K | $13K | 5.46% |
| MODEL CONSULTING INC3 Filed as: MODEL CONSULTING INC. | 3160 TREMONT AVE TREVOSE, PA 190536644 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 0.83% |
| LIGHTHOUSE GROUP3 Filed as: LIGHTHOUSE-KEUNING INSURANCE GROUP | 4808 BROADMOOR AVE SE GRAND RAPIDS, MI 49512 | DELTA DENTAL OF MICHIGAN | $6K | — | $6K | 2.99% |
| CLEVIDENCE INSURANCE SERVICES INC3 | 3000 W MACARTHUR BLVD., STE 320 SANTA ANA, CA 927047907 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $6K | $6K | 5.16% |
| MODEL CONSULTING INC3 Filed as: MODEL CONSULTING INC. | 3160 TREMONT AVE TREVOSE, PA 190536644 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 1.09% |
| LIGHTHOUSE GROUP3 Filed as: LIGHTHOUSE INSURANCE GROUP | 3597 HENRY STREET, STE 201 NORTON SHORES, MI 494416723 | VISION SERVICE PLAN | $1K | — | $1K | 5.17% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES INC. | 3000 W MACARTHUR BLVD., STE 320 SANTA ANA, CA 927047907 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $1K | $4K | 16.21% |
| MODEL CONSULTING INC3 | 3160 TREMONT AVE TREVOSE, PA 190536644 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $207 | $207 | 0.94% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 W MACARTHUR BLVD., STE 320 SANTA ANA, CA 927047907 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $1K | $3K | 16.34% |
| MODEL CONSULTING INC3 Filed as: MODEL CONSULTING INC. | 3160 TREMONT AVE TREVOSE, PA 190536644 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $199 | $199 | 0.96% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES INC. | 3000 W MACARTHUR BLVD., STE 320 SANTA ANA, CA 927047907 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $1K | $3K | 15.40% |
| MODEL CONSULTING INC3 Filed as: MODEL CONSULTING INC. | 3160 TREMONT AVE TREVOSE, PA 190536644 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $162 | $162 | 0.82% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 W MACARTHUR BLVD., STE 320 SANTA ANA, CA 927047907 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $706 | $2K | 15.69% |
| MODEL CONSULTING INC3 Filed as: MODEL CONSULTING INC. | 3160 TREMONT AVE TREVOSE, PA 190536644 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $107 | $107 | 0.86% |
| CLEVIDENCE INSURANCE SERVICES INC3 | 3000 W MACARTHUR BLVD., STE 320 SANTA ANA, CA 927047907 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $719 | $2K | 16.26% |
| MODEL CONSULTING INC3 Filed as: MODEL CONSULTING INC. | 3160 TREMONT AVE TREVOSE, PA 190536644 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $109 | $109 | 0.95% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 W MACARTHUR BLVD., STE 320 SANTA ANA, CA 927047907 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $542 | $2K | 19.54% |
| MODEL CONSULTING INC3 Filed as: MODEL CONSULTING INC. | 3160 TREMONT AVE TREVOSE, PA 190536644 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $75 | $75 | 0.90% |
| CLEVIDENCE INSURANCE SERVICES INC3 | 3000 W MACARTHUR BLVD., STE 320 SANTA ANA, CA 927047907 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $765 | $325 | $1K | 14.24% |
| MODEL CONSULTING INC3 | 3160 TREMONT AVE TREVOSE, PA 190536644 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $49 | $49 | 0.64% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 W MACARTHUR BLVD., STE 320 SANTA ANA, CA 927047907 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $123 | $123 | 8.02% |
| MODEL CONSULTING INC3 Filed as: MODEL CONSULTING INC. | 3160 TREMONT AVE TREVOSE, PA 190536644 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $17 | $17 | 1.11% |
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 | 1,156 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,040 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,196 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,535 | $6.2M |
| Dental(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 791 | $665K |
| Vision | VISION SERVICE PLAN | 108 | $23K |
| Life insurance(8 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,902 | $655K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 417 | $234K |
| Long-term disability(3 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 468 | $326K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,535 | $5.8M |
| Other(5 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 162 | $72K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,902 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.