| 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 | BLUE CROSS OF CALIFORNIA | $343K | — | $343K | 1.26% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SVCS OF CA INC | PO BOX 101162 PASADENA, CA 91189 | DELTA DENTAL OF CALIFORNIA | $187K | — | $187K | 12.93% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SVCS | PO BOX 101162 PASADENA, CA 91189 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $123K | $16K | $139K | 11.28% |
| STEVEN RAY GRIFFIN3 Filed as: STEVEN GRIFFIN | 2000 MORRIS AVE, STE 1400 BIRMINGHAM, AL 35203 | PROVIDENT LIFE AND ACCIDENT INS CO | $104K | $8K | $112K | 19.29% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SVCS OF CA INC | 2710 MEDIACENTER DR, BLDG 6 LOCKBOX 10003, STE 120 LOS ANGELES, CA 90065 | PROVIDENT LIFE AND ACCIDENT INS CO | $16K | $517 | $16K | 2.78% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS | 897 12TH ST HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INS CO | $5K | $3K | $9K | 1.47% |
| THE HORTON GROUP3 Filed as: THE HORTON GROUP INC | 10320 ORLAND PKWY ORLAND PARK, IL 60467 | PROVIDENT LIFE AND ACCIDENT INS CO | $546 | — | $546 | 0.09% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | 3635 RIVERSIDE PLAZA DRIVE SUITE 320, BULIDING M3 RIVERSIDE, CA 92506 | PROVIDENT LIFE AND ACCIDENT INS CO | $201 | — | $201 | 0.03% |
| THE HORTON GROUP3 Filed as: HORTON GROUP INC | 10320 ORLAND PKWY ORLAND PARK, IL 60467 | PROVIDENT LIFE AND ACCIDENT INS CO | $159 | — | $159 | 0.03% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SERVICES OF CA | PO BOX 101162 PASADENA, CA 91189 | VISION SERVICE PLAN | $16K | — | $16K | 3.00% |
| STEVEN RAY GRIFFIN3 Filed as: STEVEN R GRIFFIN | 2000 MORRIS AVE, STE 1400 BIRMINGHAM, AL 35203 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $87K | $11K | $99K | 18.49% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SERVICES | LOCKBOX 1003 STE 120 2710 MEDIACENTER DR BLDG 6 LOS ANGELES, CA 90065 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $17K | $827 | $18K | 3.35% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS | 897 12TH ST HAMMONTON, NJ 08037 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $11K | $410 | $11K | 2.14% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SVCS OF CA INC | PO BOX 101162 PASADENA, CA 91189 | HYATT LEGAL PLANS, INC. | $7K | $441 | $8K | 12.74% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INS SVCS OF CA | 525 MARKET STREET SUITE 3400 SAN FRANCISCO, CA 94105 | HYATT LEGAL PLANS, INC. | — | $781 | $781 | 1.28% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS RISK & INSURANCE SERVICES | 801 S FIGUEROA ST STE 700 LOS ANGELES, CA 90017 | HYATT LEGAL PLANS, INC. | — | $235 | $235 | 0.38% |
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 | 4,590 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 17 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 115 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 4,722 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 3,054 | $27.3M |
| Dental | DELTA DENTAL OF CALIFORNIA | 2,939 | $1.4M |
| Vision | VISION SERVICE PLAN | 2,832 | $542K |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 4,590 | $1.8M |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 4,590 | $1.2M |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 4,590 | $1.2M |
| Other(5 contracts, 5 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 4,590 | $2.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,590 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.