| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SVCS OF CA | 801 S FIGUEROA ST, STE 800 LOS ANGELES, CA 90017 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | $507K | — | $507K | 2.18% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SVCS OF CA INC | PO BOX 101162 PASADENA, CA 91189 | DELTA DENTAL OF CALIFORNIA | $185K | — | $185K | 8.73% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SVCS | PO BOX 101162 PASADENA, CA 91189 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $119K | $18K | $137K | 11.50% |
| STEVEN RAY GRIFFIN3 Filed as: STEVEN GRIFFIN | 2000 MORRIS AVE, STE 1400 BIRMINGHAM, AL 35203 | PROVIDENT LIFE AND ACCIDENT INS CO | $74K | $9K | $83K | 14.95% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SVCS OF CA INC | 2710 MEDIACENTER DR, BLDG 6 LOS ANGELES, CA 90065 | PROVIDENT LIFE AND ACCIDENT INS CO | $13K | $529 | $14K | 2.48% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS | 897 12TH ST HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INS CO | $6K | — | $6K | 1.14% |
| THE HORTON GROUP3 Filed as: THE HORTON GROUP INC | 10320 ORLAND PARKWAY ORLAND PARK, IL 60467 | PROVIDENT LIFE AND ACCIDENT INS CO | $666 | — | $666 | 0.12% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | 3635 RIVERSIDE PLAZA DR BLDG M3, STE 320 RIVERSIDE, CA 92506 | PROVIDENT LIFE AND ACCIDENT INS CO | $255 | — | $255 | 0.05% |
| THE HORTON GROUP3 Filed as: HORTON GRP DBA BEAR PAW BENEFITS | 10320 ORLAND PKWY ORLAND PARK, IL 60467 | PROVIDENT LIFE AND ACCIDENT INS CO | $176 | — | $176 | 0.03% |
| STEVEN RAY GRIFFIN3 Filed as: STEVEN R GRIFFIN | 2000 MORRIS AVE, STE 1400 BIRMINGHAM, AL 35203 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $64K | $9K | $72K | 13.64% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SVCS OF CA INC | 2710 MEDIACENTER DR, BLDG 6 STE 120 LOS ANGELES, CA 90065 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $15K | $951 | $16K | 3.03% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS | 897 12TH ST HAMMONTON, NJ 08037 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $12K | $193 | $12K | 2.31% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SERVICES OF CA | PO BOX 101162 PASADENA, CA 91189 | VISION SERVICE PLAN | $15K | — | $15K | 3.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SVCS OF CA INC | PO BOX 101162 PASADENA, CA 91189 | HYATT LEGAL PLANS, INC. | $6K | $1K | $7K | 11.84% |
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 | 3,929 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 13 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 121 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 4,063 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 2,741 | $23.2M |
| Dental | DELTA DENTAL OF CALIFORNIA | 2,821 | $2.1M |
| Vision | VISION SERVICE PLAN | 2,551 | $506K |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3,929 | $1.7M |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3,929 | $1.2M |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3,929 | $1.2M |
| Other(5 contracts, 5 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3,929 | $2.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,929 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.