| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 W. MACARTHUR, SUITE 320 SANTA ANA, CA 92704 | AETNA HEALTH, INC. | $21K | — | $21K | 5.01% |
| LEBHERZ INSURANCE SERVICES INC3 Filed as: LEBHERZ INSURANCE SERVICES INC. LIS | 1600 WEST HILLSDALE BLVD SAN MATEO, CA 94402 | AETNA HEALTH, INC. | $8K | — | $8K | 2.00% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES INC. | 3000 W. MACARTHUR, SUITE 320 SANTA ANA, CA 92704 | AETNA LIFE INSURANCE CO. | $15K | — | $15K | 5.71% |
| AMWINS3 Filed as: LEBHERZ INSURANCE SERVICES INC LISI | 1600 WEST HILLSDALE BLVD SAN MATEO, CA 94402 | AETNA LIFE INSURANCE CO. | $7K | — | $7K | 2.43% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 W. MACARTHUR BLVD, SUITE 320 SANTA ANA, CA 927047907 | VISION SERVICE PLAN | $937 | — | $937 | 6.14% |
| 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 | $328 | $10 | $338 | 10.30% |
| 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 | $238 | $153 | $391 | 16.44% |
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 | 88 | 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) | 89 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE CO. | 111 | $271K |
| Dental | AETNA LIFE INSURANCE CO. | 111 | $271K |
| Vision | VISION SERVICE PLAN | 79 | $15K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 88 | $6K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 88 | $6K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 111 | — |
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.