| 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 | $28K | — | $28K | 2.80% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | BLUE CROSS OF CALIFORNIA | $21K | — | $21K | 2.04% |
| AMWINS3 Filed as: LISI INC. | 1600 W. HILLSDALE BLVD. SAN MATEO, CA 94403 | BLUE CROSS OF CALIFORNIA | $6K | — | $6K | 0.57% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES INC. | 3000 W. MACARTHUR BLVD. SUITE 320 SANTA ANA, CA 92704 | UNION SECURITY INSURANCE COMPANY | $1K | — | $1K | 2.78% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | UNION SECURITY INSURANCE COMPANY | $986 | — | $986 | 2.21% |
| 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. | $1K | — | $1K | 4.57% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 911026030 | UDC DENTAL OF CALIFORNIA, INC. | $1K | — | $1K | 3.40% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES INC. | 3000 W. MACARTHUR BLVD. SUITE 320 SANTA ANA, CA 92704 | VISION SERVICE PLAN | $719 | — | $719 | 3.74% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | 3475 E. FOOTHILL BLVD. SUITE 100 PASADENA, CA 91107 | VISION SERVICE PLAN | $360 | — | $360 | 1.87% |
| 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 | $2K | $787 | $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 | $2K | $817 | $2K | 15.07% |
| 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 | $696 | $2K | 14.79% |
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 | 255 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 256 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 197 | $1.0M |
| Dental(2 contracts, 2 carriers) | UNION SECURITY INSURANCE COMPANY | 144 | $75K |
| Vision | VISION SERVICE PLAN | 176 | $19K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 288 | $31K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 288 | $16K |
| Prescription drug | BLUE CROSS OF CALIFORNIA | 197 | $1.0M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 288 | $15K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 288 | — |
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.