| 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 | BLUE CROSS OF CALIFORNIA | $31K | — | $31K | 1.42% |
| 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 | $6K | $4K | $11K | 16.37% |
| MODEL CONSULTING INC3 Filed as: MODEL CONSULTING, INC. | 3160 TREMONT AVE. TREVOSE, PA 190536644 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $573 | $573 | 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 | $2K | $6K | 20.96% |
| MODEL CONSULTING INC3 Filed as: MODEL CONSULTING INC. | 3160 TREMONT AVE. TREVOSE, PA 190536644 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $256 | $256 | 0.83% |
| 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 | — | $954 | $954 | 5.17% |
| MODEL CONSULTING INC3 Filed as: MODEL CONSULTING INC. | 3160 TREMONT AVE. TREVOSE, PA 190536644 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $132 | $132 | 0.72% |
| 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 | $1K | $463 | $2K | 20.46% |
| MODEL CONSULTING INC3 Filed as: MODEL CONSULTING, INC. | 3160 TREMONT AVE. TREVOSE, PA 190536644 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $64 | $64 | 0.75% |
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 | 555 | 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) | 556 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 257 | $2.2M |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 618 | $83K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 48 | $8K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 66 | $31K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 618 | $83K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 618 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
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.