| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES INC. | 3000 W. MACARTHUR BLVD., SUITE 320 SANTA ANA, CA 927047907 | KAISER FOUNDATION HEALTH PLANS INC. | $202K | — | $202K | 1.98% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INS SERVICES INC. | 3000 W MACARTHUR BLVD., SUITE 320 SANTA ANA, CA 92704 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $41K | $50K | $91K | 4.52% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 W MACARTHUR BLVD., STE 320 SANTA ANA, CA 92704 | HEALTH NET | $30K | — | $30K | 1.91% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 W MACARTHUR BLVD., STE 320 SANTA ANA, CA 92704 | HEALTH NET | $13K | $9K | $22K | 3.17% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES INC. | 3000 W MACARTHUR BLVD., SUITE 320 SANTA ANA, CA 927047907 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $9K | $9K | 6.86% |
| MODEL CONSULTING INC3 Filed as: MODEL CONSULTING INC. | 3160 TREMONT AVE TREVOSE, PA 190536644 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $1K | $1K | 1.04% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES INC. | 3000 W. MACARTHUR BLVD., SUITE 320 SANTA ANA, CA 927047907 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $4K | $4K | 6.43% |
| MODEL CONSULTING INC3 Filed as: MODEL CONSULTING INC. | 3160 TREMONT AVE TREVOSE, PA 190536644 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $514 | $514 | 0.89% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES INC. | 3000 W MACARTHUR BLVD., SUITE 320 SANTA ANA, CA 927047907 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $3K | $8K | 16.29% |
| MODEL CONSULTING INC3 Filed as: MODEL CONSULTING INC. | 3160 TREMONT AVE TREVOSE, PA 190536644 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $457 | $457 | 0.88% |
| CLEVIDENCE INSURANCE SERVICES INC3 | 3000 W MACARTHUR BLVD., SUITE 320 SANTA ANA, CA 927047907 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $1K | $5K | 13.23% |
| MODEL CONSULTING INC3 Filed as: MODEL CONSULTING INC. | 3160 TREMONT AVE TREVOSE, PA 190536644 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $202 | $202 | 0.49% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES INC. | 3000 W MACARTHUR BLVD., SUITE 320 SANTA ANA, CA 927047907 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $3K | $3K | 7.21% |
| MODEL CONSULTING INC3 Filed as: MODEL CONSULTING INC. | 3160 TREMONT AVE TREVOSE, PA 190536644 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $450 | $450 | 1.09% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES INC. | 3000 W MACARTHUR BLVD., SUITE 320 SANTA ANA, CA 927047907 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $3K | $7K | 16.09% |
| MODEL CONSULTING INC3 Filed as: MODEL CONSULTING INC. | 3160 TREMONT AVE TREVOSE, PA 190536644 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $348 | $348 | 0.85% |
| CLEVIDENCE INSURANCE SERVICES INC3 | 3000 W MACARTHUR BLVD., SUITE 320 SANTA ANA, CA 927047907 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $2K | $6K | 16.26% |
| MODEL CONSULTING INC3 Filed as: MODEL CONSULTING INC. | 3160 TREMONT AVE. TREVOSE, PA 190536644 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $377 | $377 | 0.95% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES INC. | 3000 W MACARTHUR BLVD., SUITE 320 SANTA ANA, CA 927047907 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $5K | 16.56% |
| MODEL CONSULTING INC3 Filed as: MODEL CONSULTING INC. | 3160 TREMONT AVE TREVOSE, PA 190536644 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $232 | $232 | 0.82% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 W MACARTHUR BLVD, SUITE 320 SANTA ANA, CA 927047907 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $739 | $739 | 7.12% |
| MODEL CONSULTING INC3 | 3160 TREMONT TREVOSE, PA 190536644 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $112 | $112 | 1.08% |
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 | 3,019 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 355 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 3,374 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLANS INC. | 2,536 | $12.5M |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 3,019 | $2.0M |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 3,019 | $2.0M |
| Life insurance(4 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 456 | $281K |
| Short-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 84 | $70K |
| Long-term disability(3 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 99 | $91K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 456 | $99K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,019 | — |
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.