| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS. SVCS WEST | 801 SOUTH FIGUEROA ST. SUITE 800 LOS ANGELES, CA 90017 | BLUE CROSS OF CALIFORNIA | $248K | — | $248K | 1.09% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS. SVCS WEST | PO BOX 101162 PASADENA, CA 91189 | DELTA DENTAL OF CALIFORNIA | $129K | — | $129K | 8.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS. SVCS WEST | PO BOX 101162 PASADENA, CA 91189 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $55K | — | $55K | 10.00% |
| WILLIS TOWERS WATSON US LLC3 | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $19K | — | $19K | 3.39% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS | PO BOX 2158 RIVERSIDE, CA 95216 | LIFE INSURANCE COMPANY OF NORTH AMERICA | -$6K | $7K | $1K | 0.22% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS. SVCS WEST | PO BOX 101162 PASADENA, CA 91189 | VISION SERVICE PLAN | $12K | — | $12K | 2.73% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | DBA CBA 2000 MORRIS AVE STE 1400 BIRMINGHAM, AL 35203 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $22K | — | $22K | 5.50% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | P.O. BOX 101162 PASADENA, CA 91189 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $11K | $371 | $11K | 2.79% |
| GRIFFIN, STEVEN, RAY3 | STE 1400 2000 MORRIS AVE BIRMINGHAM, AL 35203 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $10K | — | $10K | 2.41% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS INC. | AN AON COMPANY 897 12TH ST HAMMONTON, NJ 08037 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | $125 | $5K | 1.11% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 W GOLF RD 11TH FLOOR ROLLING MEADOWS, IL 60008 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $2K | $2K | 0.60% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS. SVCS WEST | PO BOX 101162 PASADENA, CA 91189 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $40K | — | $40K | 10.00% |
| WILLIS TOWERS WATSON US LLC3 | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $14K | — | $14K | 3.44% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS | PO BOX 2158 RIVERSIDE, CA 92516 | LIFE INSURANCE COMPANY OF NORTH AMERICA | -$3K | $5K | $2K | 0.46% |
| GRIFFIN, STEVEN, RAY3 | 2000 MORRIS AVE STE 1400 BIRMINGHAM, AL 35203 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $10K | — | $10K | 2.86% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES | DBA CBA 2000 MORRIS AVE STE 1400 BIRMINGHAM, AL 35203 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $9K | — | $9K | 2.58% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | PO BOX 101162 PASADENA, CA 91189 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $5K | $162 | $5K | 1.42% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GALLAGHER BENEFIT SERVICES INC | 2850 W GOLF RD 11TH FLOOR ROLLING MEADOWS, IL 60008 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | $2K | $2K | 0.45% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS | AON COMPANY 897 12TH ST HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1K | — | $1K | 0.40% |
| THE HORTON GROUP3 Filed as: THE HORTON GROUP INC | 10320 ORLAND PKWY ORLAND PARK, IL 60467 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $286 | — | $286 | 0.08% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCS INC | 3635 RIVERSIDE PLAZA DRIVE BUILDING M3, SUITE 320 RIVERSIDE, CA 92506 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $84 | — | $84 | 0.02% |
| THE HORTON GROUP3 Filed as: THE HORTON GROUP INC | DBA BEAR PAW BENEFITS 10320 ORLAND PKWY ORLAND PARK, IL 60467 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $61 | — | $61 | 0.02% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS. SVCS WEST | PO BOX 101162 PASADENA, CA 91189 | DELTA DENTAL OF CALIFORNIA | $22K | — | $22K | 8.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS. SVCS WEST | PO BOX 101162 PASADENA, CA 91189 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $12K | — | $12K | 10.00% |
| WILLIS TOWERS WATSON US LLC3 | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 3.36% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS | PO BOX 101162 PASADENA, CA 91189 | LIFE INSURANCE COMPANY OF NORTH AMERICA | -$2K | $2K | -$337 | -0.27% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS. SVCS WEST | PO BOX 101162 PASADENA, CA 91189 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $13K | — | $13K | 16.77% |
| WILLIS TOWERS WATSON US LLC3 | COMMISSION LOCKBOX 28852 PO BOX 28852 NEW YORK, NY 10087 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 3.08% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SVCS | PO BOX 2158 RIVERSIDE, CA 92516 | LIFE INSURANCE COMPANY OF NORTH AMERICA | -$1K | $2K | $373 | 0.46% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS. SVCS WEST | PO BOX 101162 PASADENA, CA 91189 | METLIFE LEGAL PLANS | $7K | $1K | $9K | 11.95% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS SVCS WEST | PO BOX 101162 PASADENA, CA 91189 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $209 | $2K | 13.20% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INS. SVCS WEST | PO BOX 101162 PASADENA, CA 91189 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $109 | $1K | 16.26% |
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 | 2,417 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 15 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 38 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,470 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS OF CALIFORNIA | 5,076 | $22.8M |
| Dental(2 contracts) | DELTA DENTAL OF CALIFORNIA | 2,821 | $1.9M |
| Vision | VISION SERVICE PLAN | 2,263 | $439K |
| Life insurance(4 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 3,666 | $931K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 399 | $402K |
| Long-term disability(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 287 | $141K |
| Other(7 contracts, 5 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 3,492 | $1.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 5,076 | — |
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."
No prospect flags tripped on this filing.