| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| R.L. MILSNER INC.3 | 1233 ALPINE ROAD WALNUT CREEK, CA 94596 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $387K | — | $387K | 3.65% |
| R.L. MILSNER INC.3 | 1233 ALPINE ROAD WALNUT CREEK, CA 94596 | CIGNA HEALTHCARE OF CALIFORNIA | $74K | — | $74K | 3.00% |
| R.L. MILSNER INC.3 | 1233 ALPINE ROAD WALNUT CREEK, CA 94596 | UNITED CONCORDIA INSURANCE COMPANY | $58K | — | $58K | 2.72% |
| R.L. MILSNER INC.3 | 1233 ALPINE ROAD WALNUT CREEK, CA 94596 | VISION SERVICE PLAN | $12K | — | $12K | 5.00% |
| R.L. MILSNER INC.3 | 1233 ALPINE ROAD WALNUT CREEK, CA 94596 | THE UNION LABOR LIFE INSURANCE CO. | $18K | — | $18K | 12.29% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PETER MACHI EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 1625 MARKET STREET SAN FRANCISCO, CA 94103 | $83K |
| HEALTH SERVICES & BENEFIT ADMIN EIN 94-3089465 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Copying and duplicating; Direct payment from the plan; Contract Administrator; Participant communication; Claims processing Service code 12 | — | $65K |
| WELLDYNE RX EIN 83-0338400 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $58K |
| LINDQUIST LLP EIN 52-2385296 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $54K |
| TINA CRUZ EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 1625 MARKET STREET SAN FRANCISCO, CA 94103 | $31K |
| RAEL & LETSON EIN 94-1701048 NONE | Actuarial; Direct payment from the plan; Consulting (general) Service code 11 | — | $29K |
| STEPHANIE GUERRA EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 1625 MARKET STREET SAN FRANCISCO, CA 94103 | $25K |
| R. L. MILSNER EIN 94-2494656 NONE | Direct payment from the plan; Insurance brokerage commissions and fees Service code 50 | — | $9K |
| BAKER & MCKENZIE EIN 36-2137456 NONE | Legal; Direct payment from the plan Service code 29 | — | $6K |
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 | 1,297 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 233 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,530 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,987 | $21.1M |
| Dental | UNITED CONCORDIA INSURANCE COMPANY | 3,323 | $2.1M |
| Vision | VISION SERVICE PLAN | 1,273 | $242K |
| Life insurance | THE UNION LABOR LIFE INSURANCE CO. | 1,269 | $144K |
| Prescription drug | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,987 | $10.6M |
| Other | THE UNION LABOR LIFE INSURANCE CO. | 1,269 | $29K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,323 | — |
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.