| 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 | UNITEDHEALTHCARE INSURANCE COMPANY | $110K | $0 | $110K | 5.53% |
| AMWINS3 Filed as: AMWINS CONNECT INS. SERVICES, LLC | 2677 NORTH MAIN STREET, SUITE 800 SANTA ANA, CA 92705 | UNITEDHEALTHCARE INSURANCE COMPANY | $22K | $4K | $26K | 1.30% |
| 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 | $34K | $12K | $46K | 23.12% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $6K | $6K | 3.06% |
| AMWINS3 Filed as: LISI, LLC | 2677 NORTH MAIN STREET, SUITE 800 SANTA ANA, CA 92705 | METROPOLITAN LIFE INSURANCE COMPANY | $6K | $3K | $8K | 6.67% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 WEST MACARTHUR BOULEVARD SUITE 320 SANTA ANA, CA 92704 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | $264 | $2K | 1.89% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 WEST MACARTHUR BOULEVARD SUITE 320 SANTA ANA, CA 92704 | VISION SERVICE PLAN | $1K | $0 | $1K | 4.80% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES, INC. | 3000 WEST MACARTHUR BOULEVARD SUITE 320 SANTA ANA, CA 92704 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $401 | $133 | $534 | 12.40% |
| AMWINS3 Filed as: LISI, LLC | 2677 NORTH MAIN STREET, SUITE 800 SANTA ANA, CA 92705 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $201 | $176 | $377 | 8.76% |
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 | 184 | 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) | 184 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 154 | $2.0M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 327 | $130K |
| Vision | VISION SERVICE PLAN | 171 | $25K |
| Life insurance(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 327 | $325K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 181 | $199K |
| Prescription drug | UNITEDHEALTHCARE INSURANCE COMPANY | 154 | $2.0M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 181 | $199K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 327 | — |
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.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.