| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLEVIDENCE INSURANCE SERVICES INC3 | 3000 WEST MACARTHUR BOULEVARD SUITE 320 SANTA ANA, CA 92704 | BLUE CROSS OF CALIFORNIA | $44K | $132 | $44K | 3.74% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 1600 WEST HILLSDALE BOULEVARD SAN MATEO, CA 94402 | BLUE CROSS OF CALIFORNIA | $0 | $31K | $31K | 2.61% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 WEST MACARTHUR BOULEVARD SUITE 300 SANTA ANA, CA 92704 | PRINCIPAL LIFE INSURANCE COMPANY | $996 | — | $996 | 7.91% |
| AMWINS3 Filed as: AMWINS CONNECT INSURANCE SERVICES | 1600 WEST HILLSDALE BOULEVARD SUITE 201 SAN MATEO, CA 99402 | PRINCIPAL LIFE INSURANCE COMPANY | $464 | $0 | $464 | 3.68% |
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 | 138 | 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) | 138 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 231 | $1.2M |
| Dental | BLUE CROSS OF CALIFORNIA | 231 | $1.2M |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 160 | $13K |
| Life insurance | BLUE CROSS OF CALIFORNIA | 231 | $1.2M |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 231 | $1.2M |
| Other | BLUE CROSS OF CALIFORNIA | 231 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 231 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.