| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 WEST MACARTHUR BOULEVARD SUITE 320 SANTA ANA, CA 92704 | BLUE CROSS OF CALIFORNIA | $69K | $0 | $69K | 4.47% |
| AMWINS3 Filed as: AMWINS CONNECT INS. SERVICES, LLC | 2677 NORTH MAIN STREET, SUITE 800 SANTA ANA, CA 92705 | BLUE CROSS OF CALIFORNIA | $0 | $30K | $30K | 1.97% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 WEST MACARTHUR BOULEVARD SUITE 320 SANTA ANA, CA 92704 | PRINCIPAL LIFE INSURANCE COMPANY | $1K | $0 | $1K | 7.25% |
| AMWINS3 Filed as: AMWINS CONNECT INS. SERVICES, LLC | 2677 NORTH MAIN STREET, SUITE 800 SANTA ANA, CA 92705 | PRINCIPAL LIFE INSURANCE COMPANY | $660 | $0 | $660 | 3.71% |
| GCG FINANCIAL LLC3 Filed as: ALERA GROUP, INC. | 965 GREENTREE ROAD, SUITE 110 PITTSBURGH, PA 15220 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $222 | $222 | 1.25% |
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 | 155 | 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) | 155 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 317 | $1.5M |
| Dental | BLUE CROSS OF CALIFORNIA | 317 | $1.5M |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 221 | $18K |
| Life insurance | BLUE CROSS OF CALIFORNIA | 317 | $1.5M |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 317 | $1.5M |
| Other | BLUE CROSS OF CALIFORNIA | 317 | $1.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 317 | — |
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.