| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LOCKTON COMPANIES, LLC3 | 8110 EAST UNION, SUITE 700 DENVER, CO 80237 | BLUE CROSS OF CALIFORNIA | $26K | $21K | $47K | 0.65% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INT. INS. SVS. AND OTHER AGENTS | 4371 LATHAM STREET, SUITE 101 RIVERSIDE, CA 92501 | BLUE CROSS OF CALIFORNIA | $23 | $0 | $23 | 0.00% |
| STEVEN RAY GRIFFIN3 Filed as: STEVEN R. GRIFFIN | 2000 MORRIS AVENUE, SUITE 1400 BIRMINGHAM, AL 35203 | CONTINENTAL AMERICAN INSURANCE COMPANY | $93K | $0 | $93K | 27.82% |
| AMWINS3 Filed as: AMWINS GROUP BENEFITS, INC. | 50 WHITECAP DRIVE NORTH KINGSTOW, RI 02852 | CONTINENTAL AMERICAN INSURANCE COMPANY | $12K | $0 | $12K | 3.48% |
| MICHELLE ANN DERAS3 Filed as: MICHELLE A. DERAS | PO BOX 365 WEST COVINA, CA 91793 | CONTINENTAL AMERICAN INSURANCE COMPANY | $2K | $0 | $2K | 0.65% |
| RENEE SUZANNE CORSO3 Filed as: RENEE S. CORSO | 5805 SEPULVEDA BOULEVARD, SUITE 740 SHERMAN OAKS, CA 91411 | CONTINENTAL AMERICAN INSURANCE COMPANY | $2K | $0 | $2K | 0.63% |
| RUBEN ROSA3 | 5805 SEPULVEDA BOULEVARD, SUITE 700 SHERMAN OAKS, CA 91411 | CONTINENTAL AMERICAN INSURANCE COMPANY | $1K | $0 | $1K | 0.42% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS | 897 12TH STREET HAMMONTON, NJ 08037 | CONTINENTAL AMERICAN INSURANCE COMPANY | $653 | $0 | $653 | 0.20% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INT. INS. SVS. AND OTHER AGENTS | 6701 CENTER DRIVE WEST, SUITE 1500 LOS ANGELES, CA 90045 | CONTINENTAL AMERICAN INSURANCE COMPANY | $572 | $0 | $572 | 0.17% |
| STEVEN RAY GRIFFIN3 Filed as: STEVEN R. GRIFFIN | 2000 MORRIS AVENUE, SUITE 1400 BIRMINGHAM, AL 35203 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $72K | $0 | $72K | 29.27% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS | 897 12TH STREET HAMMONTON, NJ 08037 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3K | $1K | $4K | 1.64% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $2K | $0 | $2K | 0.75% |
| AMWINS3 Filed as: AMWINS GROUP BENEFITS, INC. | 50 WHITECAP DRIVE NORTH KINGSTOWN, RI 02852 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $722 | $0 | $722 | 0.29% |
| STEVEN RAY GRIFFIN3 | 2000 MORRIS AVENUE, APARTMENT 1400 BIRMINGHAM, AL 35203 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $34K | $0 | $34K | 15.00% |
| STEVEN RAY GRIFFIN3 | 2000 MORRIS AVENUE, APARTMENT 1400 BIRMINGHAM, AL 35203 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $34K | $0 | $34K | 15.00% |
| STEVEN RAY GRIFFIN3 Filed as: STEVEN R. GRIFFIN | 2000 MORRIS AVENUE, SUITE 1400 BIRMINGHAM, AL 35203 | METROPOLITAN LIFE INSURANCE COMPANY | $70K | $0 | $70K | 32.47% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INT. INS. SVS. AND OTHER AGENTS | 6701 CENTER DRIVE WEST, SUITE 1500 LOS ANGELES, CA 90045 | METROPOLITAN LIFE INSURANCE COMPANY | -$15 | $0 | -$15 | -0.01% |
| AMWINS3 Filed as: AMWINS GROUP BENEFITS, INC. | 1 ENTERPRISE DRIVE, SUITE 210 SHELTON, CT 06484 | METROPOLITAN LIFE INSURANCE COMPANY | -$1 | -$23 | -$24 | -0.01% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | -$27 | -$27 | -0.01% |
| STEVEN RAY GRIFFIN3 | 2000 MORRIS AVENUE, APARTMENT 1400 BIRMINGHAM, AL 35203 | METROPOLITAN LIFE INSURANCE COMPANY | $42K | $0 | $42K | 20.65% |
| AMWINS3 Filed as: AMWINS GROUP BENEFITS, INC. | 1 ENTERPRISE DRIVE, SUITE 210 SHELTON, CT 06484 | METROPOLITAN LIFE INSURANCE COMPANY | -$4 | $0 | -$4 | -0.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 6701 CENTER DRIVE WEST, SUITE 1500 LOS ANGELES, CA 90045 | METROPOLITAN LIFE INSURANCE COMPANY | -$135 | $0 | -$135 | -0.07% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC | $0 | $405 | $405 | 0.36% |
| LOCKTON COMPANIES, LLC3 | 725 SOUTH FIGUEROA STREET 35TH FLOOR LOS ANGELES, CA 90017 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $2K | $4K | 10.21% |
| LOCKTON COMPANIES, LLC3 | 725 SOUTH FIGUEROA STREET 35TH FLOOR LOS ANGELES, CA 90017 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $63 | $63 | 0.68% |
| LOCKTON COMPANIES, LLC3 | 725 SOUTH FIGUEROA STREET 35TH FLOOR LOS ANGELES, CA 90017 | UNITED DENTAL CARE OF ARIZONA, INC. | $0 | $74 | $74 | 1.91% |
| LOCKTON COMPANIES, LLC3 | 725 SOUTH FIGUEROA STREET 35TH FLOOR LOS ANGELES, CA 90017 | UNITED DENTAL CARE OF NEW MEXICO, INC. | $0 | $40 | $40 | 1.95% |
| CUSTOM BENEFIT PROGRAMS INC3 Filed as: CUSTOM BENEFIT PROGRAMS | 897 12TH STREET HAMMONTON, NJ 08037 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $112 | $0 | $112 | 7.26% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $43 | $0 | $43 | 2.79% |
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 | 1,841 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,844 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 2,999 | $10.3M |
| Dental(3 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 2,999 | $7.2M |
| Vision | BLUE CROSS OF CALIFORNIA | 2,999 | $7.2M |
| Life insurance(3 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 1,798 | $514K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 599 | $225K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 12 | $9K |
| Prescription drug(4 contracts, 3 carriers) | BLUE CROSS OF CALIFORNIA | 2,999 | $10.3M |
| Other(6 contracts, 4 carriers) | CONTINENTAL AMERICAN INSURANCE COMPANY | 2,496 | $1.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,999 | — |
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.