| 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 | KAISER FOUNDATION HEALTH PLAN INC | $38K | $0 | $38K | 1.75% |
| 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. | $71K | $0 | $71K | 4.91% |
| AMWINS3 Filed as: LISI LLC | 1600 WEST HILLSDALE BOULEVARD SUITE 201 SAN MATEO, CA 94402 | AETNA HEALTH OF CALIFORNIA INC. | $14K | $0 | $14K | 0.93% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES INC. | 3000 WEST MACARTHUR BOULEVARD SUITE 320 SANTA ANA, CA 92704 | AETNA LIFE INSURANCE COMPANY | $22K | $4K | $26K | 9.25% |
| AMWINS3 Filed as: LISI LLC | 1600 WEST HILLSDALE BOULEVARD SUITE 201 SAN MATEO, CA 94402 | AETNA LIFE INSURANCE COMPANY | $1K | $0 | $1K | 0.46% |
| 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 | $7K | $2K | $9K | 12.40% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES INC. | 3000 WEST MACARTHUR BOULEVARD SUITE 320 SANTA ANA, CA 92704 | PRINCIPAL LIFE INSURANCE COMPANY | $2K | $0 | $2K | 7.39% |
| AMWINS3 Filed as: LISI LLC | 1600 WEST HILLSDALE BOULEVARD SUITE 201 SAN MATEO, CA 94402 | PRINCIPAL LIFE INSURANCE COMPANY | $640 | $816 | $1K | 6.82% |
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 | 125 | 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) | 125 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 344 | $3.9M |
| Dental | AETNA LIFE INSURANCE COMPANY | 344 | $283K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 352 | $21K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 133 | $71K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 133 | $71K |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 344 | $3.9M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 133 | $71K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 352 | — |
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.