| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AMWINS3 Filed as: AMWINS CONNECT INS SRVS, LLC | 2677 NORTH MAIN STREET, SUITE 800 SANTA ANA, CA 92705 | UNITEDHEALTHCARE INSURANCE COMPANY | $29K | $0 | $29K | 1.02% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE | 3000 WEST MACARTHUR BOULEVARD SUITE 320 SANTA ANA, CA 92704 | UNITEDHEALTHCARE INSURANCE COMPANY | $96 | $0 | $96 | 0.00% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $14K | $14K | 8.37% |
| AMWINS3 Filed as: AMWINS CONNECT INS SRVS, LLC | 2677 NORTH MAIN STREET, SUITE 800 SANTA ANA, CA 92705 | METROPOLITAN LIFE INSURANCE COMPANY | $7K | $958 | $8K | 5.36% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE | 3000 WEST MACARTHUR BOULEVARD SUITE 320 SANTA ANA, CA 92704 | METROPOLITAN LIFE INSURANCE COMPANY | $591 | $170 | $761 | 0.53% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $83 | $83 | 0.06% |
| AMWINS3 Filed as: AMWINS CONNECT INS SRVS, LLC | 2677 NORTH MAIN STREET, SUITE 800 SANTA ANA, CA 92705 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $129 | $21 | $150 | 5.34% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE | 3000 WEST MACARTHUR BOULEVARD SUITE 320 SANTA ANA, CA 92704 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $28 | $3 | $31 | 1.10% |
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 | 177 | 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) | 177 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 151 | $2.9M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 352 | $145K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 352 | $143K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 177 | $168K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 177 | $168K |
| Prescription drug | UNITEDHEALTHCARE INSURANCE COMPANY | 151 | $2.9M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 177 | $168K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 352 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.