| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SEQUOIA BENEFITS & INS SVCS LLC3 | 1850 GATEWAY DR STE 700 SAN MATEO, CA 944044067 | KAISER FOUNDATION HEALTH PLAN, INC. | $6K | $233 | $7K | 5.48% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SVCS (GA) | 32110 AGOURA RD WESTLAKE VILLAGE, CA 913614026 | KAISER FOUNDATION HEALTH PLAN, INC. | $2K | — | $2K | 1.46% |
| AMWINS3 Filed as: AMWINS CONNECT INS SVCS LLC | 1600 W HILLSDALE BLVD SAN MATEO, CA 94402 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $2K | $2K | 5.00% |
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS & INS LLC | 1850 GATEWAY DR STE 700 SAN MATEO, CA 94404 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $296 | $119 | $415 | 0.89% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $59 | $59 | 0.13% |
| AMWINS3 Filed as: AMWINS CONNECT INS SVCS LLC | 1600 W HILLSDALE BLVD SAN MATEO, CA 94402 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $2K | $2K | 4.82% |
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS & INS LLC | 1850 GATEWAY DR STE 700 SAN MATEO, CA 94402 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $409 | $112 | $521 | 1.21% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $82 | $82 | 0.19% |
| SEQUOIA BENEFITS & INS SVCS LLC3 | 1850 GATEWAY DR STE 700 SAN MATEO, CA 94404 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $79 | $3K | 10.25% |
| AMWINS3 Filed as: AMWINS CONNECT INS SVCS LLC | 1600 W HILLSDALE BLVD SAN MATEO, CA 94402 | LIFE INSURANCE COMPANY OF NORTH AMERICA | -$50 | $2K | $2K | 5.00% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | LIFE INSURANCE COMPANY OF NORTH AMERICA | -$20 | $660 | $640 | 2.00% |
| AMWINS3 Filed as: AMWINS CONNECT INS SVCS LLC | 1600 W HILLSDALE BLVD SAN MATEO, CA 94402 | LIFE INSURANCE COMPANY OF NORTH AMERICA | -$3 | $232 | $229 | 3.93% |
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS & INS LLC | 1850 GATEWAY DR STE 700 SAN MATEO, CA 94404 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $124 | $22 | $146 | 2.51% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK BEACHWOOD, OH 44122 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $25 | $25 | 0.43% |
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 | 107 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 109 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 20 | $142K |
| Dental | HAWAII MEDICAL SERVICE ASSOCIATION | 2 | $20K |
| Vision | HAWAII MEDICAL SERVICE ASSOCIATION | 2 | $20K |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 139 | $52K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 109 | $47K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 109 | $43K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 20 | $142K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 139 | $6K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 139 | — |
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.