| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SERVICES OF CA | 18101 VON KARMAN AVE., SUITE 600 IRVINE, CA 92612 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $269 | $2K | 11.17% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SERVICES OF CA | 18101 VON KARMAN AVE., SUITE 600 IRVINE, CA 92612 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | $183 | $2K | 11.27% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SERVICES OF CA | 18101 VON KARMAN AVE., SUITE 600 IRVINE, CA 92612 | EYEMED VISION CARE | $1K | — | $1K | 9.87% |
| JOHNSON RESOURCES3 | 7373 E DOUBLETREE RANCH #200 SCOTTSDALE, AZ 85258 | EYEMED VISION CARE | $215 | — | $215 | 1.98% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS INSURANCE SERVICES OF CA | 18101 VON KARMAN AVE., SUITE 600 IRVINE, CA 92612 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $922 | $172 | $1K | 21.45% |
| CROOM, ROBERT, FRINK3 | 155 BRICKLEBERRY DRIVE ROSWELL, GA 30075 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $98 | — | $98 | 4.46% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $42 | — | $42 | 1.91% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | 29A TECHNOLOGY DRIVE, SUITE 200 IRVINE, CA 92618 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $10 | $1 | $11 | 0.50% |
| IMPACT BENEFIT MANAGEMENT SERVICES3 Filed as: IMPACT BENEFIT MANAGEMENT SVCS. INC | 3650 MANSELL ROAD, SUITE 100 ALPHRETTA, GA 30022 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $22 | — | $22 | 1.42% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BOLTON & COMPANY | P.O. BOX 6030 PASADENA, CA 91102 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $14 | — | $14 | 0.90% |
| CROOM, ROBERT, FRINK3 | 155 BRICKLEBERRY DRIVE ROSWELL, GA 30075 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $11 | — | $11 | 0.71% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | 29A TECHNOLOGY DRIVE, SUITE 200 IRVINE, CA 92618 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $10 | — | $10 | 0.64% |
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 | 1,186 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,195 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 32 | $2K |
| Vision | EYEMED VISION CARE | 990 | $11K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,186 | $36K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 194 | $5K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,186 | $15K |
| Other(4 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 1,186 | $40K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,186 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.