| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLEVIDENCE INSURANCE SERVICES INC3 | 3000 W. MACARTHUR BLVD., SUITE 320 SANTA ANA, CA 92704 | BLUE SHIELD OF CALIFORNIA | $41K | — | $41K | 4.00% |
| AMWINS3 Filed as: LISI, INC. | 1600 W HILLSDALE BLVD. SAN MATEO, CA 94402 | BLUE SHIELD OF CALIFORNIA | $20K | — | $20K | 2.00% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES INC. | 3000 W. MACARTHUR BLVD., SUITE 320 SANTA ANA, CA 92704 | UNION SECURITY INSURANCE COMPANY | $2K | — | $2K | 5.00% |
| CLEVIDENCE INSURANCE SERVICES INC3 | 3000 W. MACARTHUR BLVD., SUITE 320 SANTA ANA, CA 92704 | UNION SECURITY INSURANCE COMPANY | $2K | — | $2K | 8.00% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 W MACARTHUR BLVD., STE 320 SANTA ANA, CA 927047907 | VISION SERVICE PLAN | $989 | — | $989 | 5.92% |
| 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 | $1K | $908 | $2K | 18.36% |
| CLEVIDENCE INSURANCE SERVICES INC3 | 3000 W. MACARTHUR BLVD., SUITE 320 SANTA ANA, CA 92704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $900 | $541 | $1K | 16.02% |
| 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 | $765 | $368 | $1K | 14.82% |
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 | 210 | 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) | 210 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE SHIELD OF CALIFORNIA | 190 | $1.0M |
| Dental(2 contracts) | UNION SECURITY INSURANCE COMPANY | 109 | $67K |
| Vision | VISION SERVICE PLAN | 150 | $17K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 216 | $20K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 216 | $8K |
| Prescription drug | BLUE SHIELD OF CALIFORNIA | 190 | $1.0M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 216 | $9K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 216 | — |
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.