| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 WEST MACARTHUR BOULEVARD SUITE 320 SANTA ANA, CA 92704 | KAISER FOUNDATION HEALTH PLAN, INC. | $402K | $0 | $402K | 2.07% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 WEST MACARTHUR BOULEVARD SUITE 320 SANTA ANA, CA 92704 | UNITEDHEALTHCARE INSURANCE COMPANY | $136K | $179K | $316K | 4.73% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 WEST MACARTHUR BOULEVARD SUITE 320 SANTA ANA, CA 92704 | METROPOLITAN LIFE INSURANCE COMPANY | $54K | $74K | $128K | 4.33% |
| CLEVIDENCE INSURANCE SERVICES INC5 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 WEST MACARTHUR BOULEVARD SUITE 320 SANTA ANA, CA 92704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $10K | $58K | $68K | 5.93% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $43K | $43K | 3.76% |
| FMLASOURCE INC5 Filed as: FMLASOURCE INC. | 455 NORTH CITYFRONT PLAZA DRIVE 13TH FLOOR CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $10K | $10K | 0.89% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 WEST MACARTHUR BOULEVARD SUITE 320 SANTA ANA, CA 92704 | BLUE CROSS OF CALIFORNIA | $6K | $0 | $6K | 2.00% |
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 | 4,450 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 663 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 5,113 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 2,671 | $26.1M |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 7,444 | $2.9M |
| Vision | BLUE CROSS OF CALIFORNIA | 6,860 | $312K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,448 | $1.1M |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,448 | $1.1M |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,448 | $1.1M |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 2,671 | $26.1M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 1,448 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 7,444 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.