| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 575 ANTON BOULEVARD, SUITE 610 COSTA MESA, CA 92626 | BLUE CROSS OF CALIFORNIA | $37K | $16K | $53K | 2.85% |
| AMWINS3 Filed as: LISI, LLC | 1600 WEST HILLSDALE BOULEVARD SAN MATEO, CA 94402 | BLUE CROSS OF CALIFORNIA | $0 | $9K | $9K | 0.49% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 WEST MACARTHUR BOULEVARD SUITE 320 SANTA ANA, CA 92704 | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | $1K | $3K | $4K | 23.06% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 WEST MACARTHUR BOULEVARD SUITE 320 SANTA ANA, CA 92704 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | $0 | $1K | 10.00% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 WEST MACARTHUR BOULEVARD SUITE 320 SANTA ANA, CA 92704 | UNITED CONCORDIA INSURANCE COMPANY | $1K | $3K | $4K | 29.57% |
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 | 134 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 134 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 225 | $1.9M |
| Dental(2 contracts, 2 carriers) | UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | 139 | $31K |
| Vision | RELIANCE STANDARD LIFE INSURANCE COMPANY | 176 | $14K |
| Life insurance | BLUE CROSS OF CALIFORNIA | 225 | $1.9M |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 225 | $1.9M |
| Other | BLUE CROSS OF CALIFORNIA | 225 | $1.9M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 225 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.