| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS, LLC | 1850 GATEWAY DRIVE, SUITE 700 SAN MATEO, CA 94404 | KAISER FOUNDATION HEALTH PLAN INC | $15K | $996 | $16K | 5.16% |
| AMWINS3 Filed as: LISI, INC. | 1600 W HILLSDALE BLVD STE 201 SAN MATEO, CA 94402 | KAISER FOUNDATION HEALTH PLAN INC | $8K | — | $8K | 2.45% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL OF CA INS SVCS | PO BOX 2158 RIVERSIDE, CA 92516 | KAISER FOUNDATION HEALTH PLAN INC | — | $396 | $396 | 0.13% |
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS LLC | 1850 GATEWAY DRIVE, SUITE 700 SAN MATEO, CA 94404 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $21K | $960 | $22K | 10.38% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INS AGENCY & FIN SVCS | 12404 PARK CENTRAL DR. SUITE 400S DALLAS, TX 75251 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | $7K | $7K | 3.41% |
| GREGORY S GOLUB3 Filed as: GREGORY S. GOLUB | 1850 GATEWAY DRIVE SUITE 600 SAN MATEO, CA 94404 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $5K | $155 | $5K | 3.28% |
| SEQUOIA BENEFITS & INS SVCS LLC3 | 1850 GATEWAY DRIVE, SUITE 700 SAN MATEO, CA 94404 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $1K | $4K | 14.66% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $571 | $571 | 2.00% |
| SEQUOIA BENEFITS & INS SVCS LLC3 | 1850 GATEWAY DRIVE, SUITE 700 SAN MATEO, CA 94404 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $1K | $3K | 14.18% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $482 | $482 | 2.00% |
| SEQUOIA BENEFITS & INS SVCS LLC3 | 1850 GATEWAY DRIVE, SUITE 700 SAN MATEO, CA 94404 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | $988 | $3K | 14.17% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $474 | $474 | 2.00% |
| SEQUOIA BENEFITS & INS SVCS LLC3 | 1850 GATEWAY DRIVE, SUITE 700 SAN MATEO, CA 94404 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $795 | $375 | $1K | 14.71% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $159 | $159 | 2.00% |
| SEQUOIA BENEFITS & INS SVCS LLC3 | 72 MADISON AVE 2ND FL NEW YORK, NY 10001 | FEDERAL INSURANCE COMPANY | $673 | — | $673 | 14.99% |
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 | 194 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 194 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 56 | $480K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 210 | $207K |
| Vision | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 210 | $207K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 212 | $29K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 189 | $24K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 189 | $24K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 56 | $480K |
| Other(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 212 | $12K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 212 | — |
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.