| 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 | BLUE CROSS OF CALIFORNIA | $292K | $6K | $298K | 4.08% |
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS LLC | 1850 GATEWAY DR, STE 700 SAN MATEO, CA 94404 | KAISER FOUNDATION HEALTH PLAN INC. | $2K | $1 | $2K | 0.27% |
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS AND INS. SVCS LLC | 1850 GATEWAY DRIVE, SUITE 700 SAN MATEO, CA 94404 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $35K | $13K | $48K | 17.88% |
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS & INS. SERVICES | 1850 GATEWAY DR SUITE 700 SAN MATEO, CA 94404 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE CO. | $3K | $87 | $3K | 5.47% |
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 | 380 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 13 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 393 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 807 | $8.2M |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 481 | $267K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 481 | $267K |
| Life insurance(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 481 | $328K |
| Short-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 481 | $267K |
| Long-term disability | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 481 | $267K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 88 | $895K |
| Other(2 contracts, 2 carriers) | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 481 | $328K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 807 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.