| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS AND INS. SVCS, LLC | 1850 GATEWAY DRIVE, SUITE 600 SAN MATEO, CA 94404 | BLUE CROSS OF CALIFORNIA | $52K | $10 | $52K | 4.49% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 3390 UNIVERSITY AVENUE, SUITE 300 RIVERSIDE, CA 92501 | BLUE CROSS OF CALIFORNIA | $5K | — | $5K | 0.40% |
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS AND INS. SVCS, LLC | 1850 GATEWAY DRIVE, SUITE 600 SAN MATEO, CA 94404 | KAISER FOUNDATION HEALTH PLAN INC | $15K | $1K | $16K | 3.56% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 4047 CONCORD, CA 94524 | KAISER FOUNDATION HEALTH PLAN INC | $3K | — | $3K | 0.76% |
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS AND INS. SVCS, LLC | 1850 GATEWAY DRIVE, SUITE 600 SAN MATEO, CA 94404 | METROPOLITAN LIFE INSURANCE COMPANY | $12K | $3K | $15K | 11.24% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 180 SUTTER STREET, SUITE 400 SAN FRANCISCO, CA 94104 | METROPOLITAN LIFE INSURANCE COMPANY | $999 | — | $999 | 0.76% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 5345 RIVERSIDE, CA 92517 | METROPOLITAN LIFE INSURANCE COMPANY | — | $100 | $100 | 0.08% |
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS AND INS. SVCS, LLC | 1850 GATEWAY DRIVE, SUITE 600 SAN MATEO, CA 94404 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 8.25% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS SVCES., INC. | PO BOX 2158 RIVERSIDE, CA 92516 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $688 | — | $688 | 1.75% |
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS AND INS. SVCS, LLC | 1850 GATEWAY DRIVE, SUITE 600 SAN MATEO, CA 94404 | VISION SERVICE PLAN | $887 | — | $887 | 5.26% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 4047 CONCORD, CA 94524 | VISION SERVICE PLAN | $107 | — | $107 | 0.63% |
| SEQUOIA BENEFITS & INS SVCS LLC3 Filed as: SEQUOIA BENEFITS AND INS. SVCS, LLC | 1850 GATEWAY DRIVE, SUITE 600 SAN MATEO, CA 94404 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $881 | $195 | $1K | 11.04% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | 180 SUTTER STREET, SUITE 400 SAN FRANCISCO, CA 94104 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $83 | — | $83 | 0.85% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: HUB INTERNATIONAL INS. SVCES., INC. | PO BOX 5345 RIVERSIDE, CA 92517 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | — | $8 | $8 | 0.08% |
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 | 147 | 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) | 147 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 160 | $1.6M |
| Dental(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 244 | $141K |
| Vision | VISION SERVICE PLAN | 136 | $17K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 147 | $39K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 147 | $39K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 160 | $1.6M |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY | 147 | $39K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 244 | — |
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.