| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CAPITOL BENEFITS, LLC3 Filed as: CAPITOL BENEFITS LLC | 364 MAIN ST FL 2 GAITHERSBURG, MD 20878 | KAISER FOUNDATION HEALTH PLAN INC. | $2K | — | $2K | 3.67% |
| AMWINS3 Filed as: LISI, INC. (GA) | 1600 W HILLSDALE BLVD STE 201 SAN MATEO, CA 94402 | KAISER FOUNDATION HEALTH PLAN INC. | $1K | — | $1K | 2.79% |
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS & INSURANCE SVCS | 1850 GATEWAY DRIVE, SUITE 700 SAN MATEO, CA 94404 | KAISER FOUNDATION HEALTH PLAN INC. | $721 | — | $721 | 1.40% |
| SEQUOIA BENEFITS & INS SVCS LLC3 | 1850 GATEWAY DRIVE, SUITE 700 SAN MATEO, CA 94404 | KAISER FOUNDATION HEALTH PLAN INC. | $3K | — | $3K | 5.49% |
| AMWINS3 Filed as: LISI, INC. | 1600 W HILLSDALE BLVD STE 201 SAN MATEO, CA 94402 | KAISER FOUNDATION HEALTH PLAN INC. | $1K | — | $1K | 2.50% |
| SEQUOIA BENEFITS & INS SVCS LLC3 | 1850 GATEWAY DRIVE, SUITE 700 SAN MATEO, CA 94404 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC | $3K | — | $3K | 6.14% |
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 | 221 | 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) | 221 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 10 | $147K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 295 | $20K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 253 | $71K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 253 | $35K |
| Prescription drug(3 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN INC. | 10 | $147K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 253 | $6K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 295 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.