| 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 | HEALTH NET | $15K | $7K | $22K | 2.64% |
| CLEVIDENCE INSURANCE SERVICES INC3 | 3000 W MACARTHUR BLVD., SUITE 320 SANTA ANA, CA 927047907 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $3K | $9K | 15.60% |
| MODEL CONSULTING INC3 | 3160 TREMONT AVE TREVOSE, PA 190536644 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $475 | $475 | 0.85% |
| CLEVIDENCE INSURANCE SERVICES INC3 | 3000 W MACARTHUR BLVD., SUITE 320 SANTA ANA, CA 927047907 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $3K | $3K | 4.74% |
| MODEL CONSULTING INC3 | 3160 TREMONT AVE TREVOSE, PA 190536644 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $418 | $418 | 0.75% |
| CLEVIDENCE INSURANCE SERVICES INC3 | 3000 W MACARTHUR BLVD., SUITE 320 SANTA ANA, CA 927047907 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 4.93% |
| MODEL CONSULTING INC3 | 3160 TREMONT AVE TREVOSE, PA 190536644 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $188 | $188 | 0.75% |
| CLEVIDENCE INSURANCE SERVICES INC3 | 3000 W MACARTHUR BLVD., SUITE 320 SANTA ANA, CA 927047907 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $827 | $2K | 15.08% |
| MODEL CONSULTING INC3 Filed as: MODEL CONSULTING INC. | 3160 TREMONT AVE TREVOSE, PA 190536644 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $125 | $125 | 0.77% |
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 | 222 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 223 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTH NET | 72 | $832K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 245 | $81K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 63 | $16K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 246 | $56K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 245 | $81K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 246 | — |
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.