| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NEW CITY EXECUTIVE INSURANCE SERVIC3 Filed as: NEW CITY EXECUTIVE INS SVCS LLC | 600 B ST STE 300 SAN DIEGO, CA 92101 | BLUE CROSS OF CALIFORNIA | $5K | — | $5K | 3.47% |
| CENTERSTONE INSURANCE AND FINANCIAL3 Filed as: CENTERSTONE INSURANCE AND FIN. SVCS | 12404 PARK CENTRAL DR STE 400S DALLAS, TX 75251 | BLUE CROSS OF CALIFORNIA | — | $3K | $3K | 2.11% |
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS AND INS SVCS LLC | 1850 GATEWAY DR, SUITE 700 SAN MATEO, CA 94404 | BLUE CROSS OF CALIFORNIA | $2K | $1 | $2K | 1.23% |
| NEW CITY EXECUTIVE INSURANCE SERVIC3 Filed as: NEW CITY EXECUTIVE INS SVCS LLC | 550 W B ST #400 SAN DIEGO, CA 92101 | KAISER FOUNDATION HEALTH PLAN INC | $4K | — | $4K | 3.62% |
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS AND INS SVCS LLC | 1850 GATEWAY DR, SUITE 700 SAN MATEO, CA 94404 | KAISER FOUNDATION HEALTH PLAN INC | $1K | — | $1K | 1.17% |
| NEW CITY EXECUTIVE INSURANCE SERVIC3 Filed as: NEW CITY EXECUTIVE INS SVCS LLC | 550 W B ST #400 SAN DIEGO, CA 92101 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $2K | — | $2K | 6.88% |
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS AND INS SVCS LLC | 1850 GATEWAY DR, SUITE 600 SAN MATEO, CA 94404 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $979 | — | $979 | 3.65% |
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 | 102 | 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) | 102 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 76 | $252K |
| Dental | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 117 | $27K |
| Vision | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 117 | $27K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 61 | $100K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 117 | — |
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.
Final-filing indicator set. Plan is winding down; don't waste sales effort here.