| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES INC. | 3000 WEST MACARTHUR BOULEVARD SANTA ANA, CA 92704 | AETNA HEALTH OF CALIFORNIA INC. | $68K | $0 | $68K | 3.96% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES INC. | 3000 WEST MACARTHUR BOULEVARD SANTA ANA, CA 92704 | HEALTH PLAN OF NEVADA | $9K | $0 | $9K | 4.02% |
| 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 | $12K | $7K | $19K | 15.55% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES INC. | 3000 WEST MACARTHUR BOULEVARD SANTA ANA, CA 92704 | AETNA LIFE INSURANCE COMPANY | $15K | $8K | $23K | 19.84% |
| AHSBROOK-CLEVIDENCE INC.3 | 3000 WEST MACARTHUR BOULEVARD SUITE 320 SANTA ANA, CA 92704 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | $239 | $2K | 9.36% |
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 | 428 | 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) | 428 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | AETNA HEALTH OF CALIFORNIA INC. | 421 | $2.1M |
| Dental | AETNA LIFE INSURANCE COMPANY | 421 | $118K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 382 | $23K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 417 | $121K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 417 | $121K |
| Prescription drug(3 contracts, 3 carriers) | AETNA HEALTH OF CALIFORNIA INC. | 421 | $2.1M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 417 | $121K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 421 | — |
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.