| 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 | BLUE CROSS OF CALIFORNIA | $39K | — | $39K | 4.90% |
| AMWINS3 Filed as: LISI INC. | 1600 W. HILLSDALE BLVD. SAN MATEO, CA 94403 | BLUE CROSS OF CALIFORNIA | $8K | — | $8K | 1.00% |
| 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 | 5.09% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES INC. | 3000 W. MACARTHUR BLVD. SUITE 320 SANTA ANA, CA 92704 | UDC DENTAL OF CALIFORNIA, INC. | $2K | — | $2K | 8.38% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES INC. | 3000 W. MACARTHUR BLVD. SUITE 320 SANTA ANA, CA 92704 | VISION SERVICE PLAN | $1K | — | $1K | 5.88% |
| 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 | $652 | $2K | 14.79% |
| 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 | $459 | $2K | 13.50% |
| 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 | $540 | $2K | 14.65% |
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 | 246 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 249 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 179 | $799K |
| Dental(2 contracts, 2 carriers) | UNION SECURITY INSURANCE COMPANY | 131 | $72K |
| Vision | VISION SERVICE PLAN | 166 | $17K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 240 | $25K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 240 | $13K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 179 | $799K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 240 | $12K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 240 | — |
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.