| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS & INS. SERVICES | 1850 GATEWAY DR SUITE 700 SAN MATEO, CA 94404 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $68K | $15K | $83K | 3.92% |
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS & INS. SERVICES | 1850 GATEWAY DR SUITE 700 SAN MATEO, CA 94404 | METROPOLITAN LIFE INSURANCE COMPANY | — | $12 | $12 | 0.01% |
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS & INS. SERVICES | 1850 GATEWAY DR SUITE 700 SAN MATEO, CA 94404 | KAISER FOUNDATION HEALTH PLAN INC | — | $1K | $1K | 2.88% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INSURANCE SERVICE | PO BOX 4047 CONCORD, CA 94524 | UNICARE LIFE & HEALTH INSURANCE COMPANY | — | $5K | $5K | 14.68% |
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS & INS. SERVICES | 1850 GATEWAY DR SUITE 700 SAN MATEO, CA 94404 | METROPOLITAN LIFE INSURANCE COMPANY | — | $12 | $12 | 0.18% |
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS & INS. SERVICES | 1850 GATEWAY DR SUITE 700 SAN MATEO, CA 94404 | METROPOLITAN LIFE INSURANCE COMPANY | — | $12 | $12 | 0.25% |
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS & INS. SERVICES | 1850 GATEWAY DR SUITE 700 SAN MATEO, CA 94404 | METROPOLITAN LIFE INSURANCE COMPANY | — | $12 | $12 | 0.27% |
| FNA INSURANCE SERVICES INC3 | 1000 WOODBURY RD STE 403 WOODBURY, NY 11797 | EMPIRE BLUE CROSS AND BLUE SHIELD | — | $641 | $641 | 19.14% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL NORTHEAST LIMITED | 1000 WOODBURY ROAD WOODBURY, NY 11797 | EMPIRE BLUE CROSS AND BLUE SHIELD | $627 | — | $627 | 18.72% |
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 | 151 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 156 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(6 contracts, 4 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 333 | $2.2M |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL | 343 | $143K |
| Vision(2 contracts, 2 carriers) | EYEMED VISION CARE ON BEHALF OF THE FIDELITY SECURITY LIFE INS. CO. NY | 283 | $22K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 289 | $125K |
| Short-term disability(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 289 | $125K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 289 | $91K |
| Prescription drug(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 333 | $2.2M |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 289 | $91K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 343 | — |
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.