| 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 | AETNA HEALTH OF CALIFORNIA, INC. | $20K | $0 | $20K | 4.57% |
| AMWINS3 Filed as: AMWINS CONNECT INS. SERVICES, LLC | 1600 WEST HILLSDALE BOULEVARD SUITE 201 SAN MATEO, CA 94402 | AETNA HEALTH OF CALIFORNIA, INC. | $2K | $0 | $2K | 0.46% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 WEST MACARTHUR BOULEVARD SUITE 320 SANTA ANA, CA 92704 | AETNA LIFE INSURANCE COMPANY | $16K | $0 | $16K | 5.65% |
| AMWINS3 Filed as: AMWINS CONNECT INS. SERVICES, LLC | 1600 WEST HILLSDALE BOULEVARD SUITE 201 SAN MATEO, CA 94402 | AETNA LIFE INSURANCE COMPANY | $1K | $0 | $1K | 0.36% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 WEST MACARTHUR BOULEVARD SUITE 320 SANTA ANA, CA 92704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $744 | $373 | $1K | 15.00% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $186 | $186 | 2.50% |
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 | 127 | 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) | 127 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | AETNA HEALTH OF CALIFORNIA, INC. | 179 | $761K |
| Dental | AETNA LIFE INSURANCE COMPANY | 179 | $289K |
| Vision | AETNA LIFE INSURANCE COMPANY | 179 | $289K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 124 | $7K |
| Prescription drug(2 contracts, 2 carriers) | AETNA LIFE INSURANCE COMPANY | 179 | $327K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 124 | $7K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 179 | — |
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.