| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLEVIDENCE INSURANCE SERVICES INC3 | 575 ANTON BLVD, SUITE 610 COSTA MESA, CA 92626 | BLUE CROSS OF CALIFORNIA | $68K | — | $68K | 5.71% |
| AMWINS3 Filed as: LISI INC. | 1600 WEST HILLSDALE BLVD SAN MATEO, CA 94402 | BLUE CROSS OF CALIFORNIA | — | $34K | $34K | 2.90% |
| CLEVIDENCE INSURANCE SERVICES INC3 | 3000 W MACARTHUR BLVD, STE 320 SANTA ANA, CA 92704 | BLUE CROSS OF CALIFORNIA | $645 | — | $645 | 0.05% |
| CLEVIDENCE INSURANCE SERVICES INC3 | 3000 W MACARTHUR BLVD, SUITE 320 SANTA ANA, CA 927047907 | KAISER FOUNDATION HEALTH PLAN INC | $4K | — | $4K | 3.61% |
| CLEVIDENCE INSURANCE SERVICES INC3 | 3000 W MACARTHUR BLVD, STE 320 SANTA ANA, CA 92704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $2K | $6K | 15.49% |
| CLEVIDENCE INSURANCE SERVICES INC3 Filed as: CLEVIDENCE INSURANCE SERVICES INC. | 3000 W MACARTHUR BLVD, STE 320 SANTA ANA, CA 92704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $985 | $3K | 14.98% |
| CLEVIDENCE INSURANCE SERVICES INC3 | 3000 W MACARTHUR BLVD, STE 320 SANTA ANA, CA 92704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $594 | $2K | 15.62% |
| CLEVIDENCE INSURANCE SERVICES INC3 | 3000 W MACARTHUR BLVD, STE 320 SANTA ANA, CA 92704 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $801 | $464 | $1K | 15.79% |
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 | 357 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 361 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 339 | $1.3M |
| Dental | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 434 | $131K |
| Vision | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 434 | $131K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 357 | $47K |
| Long-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 149 | $28K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 339 | $1.3M |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 357 | $47K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 434 | — |
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.