| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 W MACARTHUR BLVD., SUITE 320 SANTA ANA, CA 92704 | HEALTH NET | $76K | $24K | $100K | 6.25% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES INC. | 3000 W MACARTHUR BLVD., SUITE 320 SANTA ANA, CA 92704 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $14K | — | $14K | 9.91% |
| AMWINS3 Filed as: LISI INC. | 1600 W HILLSDALE BLVD SAN MATEO, CA 94402 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $6K | $6K | 3.96% |
| CLEVIDENCE INSURANCE SERVICES INC3 | 3000 W MACARTHUR BLVD SUITE 320 SANTA ANA, CA 927047907 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $2K | $8K | 13.73% |
| THOMAS EDWARD BRADBURY3 | 35 BLUE HERON DR FLETCHER, NC 287327539 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 4.95% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES INC. | 3000 W MACARTHUR BLVD., SUITE 320 SANTA ANA, CA 92704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $553 | $3K | 11.89% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 W. MACARTHUR BLVD., SUITE 320 SANTA ANA, CA 92704 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $8K | — | $8K | 33.01% |
| AMWINS3 Filed as: LISI, INC. | 1600 W HILLSDALE BLVD. SAN MATEO, CA 94403 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | — | $2K | $2K | 9.68% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 W. MACARTHUR BLVD., STE 320 SANTA ANA, CA 92704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $908 | $3K | 15.57% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES INC. | 3000 W. MACARTHUR BLVD., SUITE 320 SANTA ANA, CA 92704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $291 | $291 | 2.02% |
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 | 369 | 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) | 370 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTH NET | 255 | $1.6M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 283 | $140K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 266 | $25K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 369 | $75K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 60 | $29K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 59 | $14K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 369 | $75K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 369 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.