| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| PCF INSURANCE SERVICES OF THE WEST3 | 21300 VICTORY BLVD. STE.700 WOODLAND HILLS, CA 91367 | BLUE SHIELD OF CALIFORNIA | — | $636K | $636K | 2.87% |
| PCF INSURANCE SERVICES OF THE WEST3 | 21300 VICTORY BLVD. STE.700 WOODLAND HILLS, CA 91367 | BLUE SHIELD OF CALIFORNIA | — | $561 | $561 | 0.00% |
| PCF INSURANCE SERVICES OF THE WEST3 Filed as: PCF INS. SERVICES OF THE WEST, LLC | 1233 ALPINE ROAD STE 201 WALNUT CREEK, CA 94596 | KAISER FOUNDATION HEALTH PLAN INC. | $278K | — | $278K | 2.12% |
| PCF INSURANCE SERVICES OF THE WEST3 Filed as: PCF INS. SERVICES OF THE WEST, LLC | 1233 ALPINE ROAD STE 201 WALNUT CREEK, CA 94596 | KAISER FOUNDATION HEALTH PLAN INC. | $15K | — | $15K | 1.75% |
| PCF INSURANCE SERVICES OF THE WEST3 Filed as: PCF INS. SERVICES OF THE WEST, LLC | 1233 ALPINE ROAD STE. 200 WALNUT CREEK, CA 94596 | VISION SERVICE PLAN | $19K | — | $19K | 4.60% |
| THE SEGAL COMPANY3 Filed as: THE SEGAL COMPANY (WESTERN STATES) | — | VISION SERVICE PLAN | $2K | — | $2K | 0.38% |
| PCF INSURANCE SERVICES OF THE WEST3 Filed as: PCF INS. SERVICES OF THE WEST, LLC | 6200 CANOGA AVE. STE. 325 WOODLAND HILLS, CA 91367 | THE UNION LABOR LIFE INSURANCE CO. | $22K | — | $22K | 9.83% |
| PCF INSURANCE SERVICES OF THE WEST3 Filed as: PCF INS. SERVICES OF THE WEST, LLC | 1233 ALPINE ROAD WALNUT CREEK, CA 94596 | DELTA DENTAL OF CALIFORNIA | $69K | — | $69K | 419.76% |
| PCF INSURANCE SERVICES OF THE WEST3 Filed as: PCF INS. SERVICES OF THE WEST, LLC | 1233 ALPINE ROAD WALNUT CREEK, CA 94596 | GUARDIAN LIFE INSURANCE CO OF AMERICA | $1K | — | $1K | 14.07% |
| WILLNER-CARDINET-KIDWELL3 | 333 N INDIAN HILL BLVD CLAREMONT, CA 91711 | GUARDIAN LIFE INSURANCE CO OF AMERICA | $21 | — | $21 | 0.28% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| LAW FIRM OF JAMES P. BAKER EIN 87-3996649 NONE | Legal; Direct payment from the plan Service code 29 | — | $225K |
| BEAT IT! PROGRAM, INC. EIN 77-0111619 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $148K |
| DELTA DENTAL OF CALIFORNIA EIN 94-1461312 NONE | Direct payment from the plan; Claims processing; Plan Administrator Service code 12 | — | $120K |
| WITHUMSMITH+BROWN, PC EIN 22-2027092 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $105K |
| MARIA RIVERA EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 1621 MARKET STREET, SUITE 400 SAN FRANCISCO, CA 94103 | $87K |
| CLAREMONT BEHAVIORAL SERVICES, INC. EIN 94-3129474 NONE | Claims processing; Direct payment from the plan; Other services Service code 12 | — | $85K |
| JILLIAN BAIRES EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 1621 MARKET STREET, SUITE 400 SAN FRANCISCO, CA 94103 | $63K |
| WELLDYNERX, LLC EIN 84-1515837 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $60K |
| NICOLE ESCOBAR EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 1621 MARKET STREET, SUITE 400 SAN FRANCISCO, CA 94103 | $60K |
| JENNIFER CAMPUZANO EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | 1621 MARKET STREET, SUITE 400 SAN FRANCISCO, CA 94103 | $55K |
| GARRETT FROSS EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | 1621 MARKET STREET, SUITE 400 SAN FRANCISCO, CA 94103 | $54K |
| STEPHANIE GUERRA EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 1621 MARKET STREET, SUITE 400 SAN FRANCISCO, CA 94103 | $52K |
| TINA FAN EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | 1621 MARKET STREET, SUITE 400 SAN FRANCISCO, CA 94103 | $50K |
| SOLXSYS ADMINISTRATIVE SOLUTIONS EIN 83-2454243 NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $49K |
| CHIARA FRANCO EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | 1621 MARKET STREET, SUITE 400 SAN FRANCISCO, CA 94103 | $43K |
| WILLIAM OLINGER EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 1621 MARKET STREET, SUITE 400 SAN FRANCISCO, CA 94103 | $31K |
| RAEL & LETSON EIN 94-1701048 NONE | Actuarial; Direct payment from the plan; Consulting (general) Service code 11 | — | $23K |
| MORGAN STANLEY EIN 11-3658445 NONE | Investment advisory (plan); Other investment fees and expenses; Direct payment from the plan; Other services; Securities brokerage commissions and fees; Securities brokerage; Other commissions Service code 27 | — | $23K |
| PRO PRINT EIN 94-3260648 NONE | Copying and duplicating; Direct payment from the plan Service code 36 | — | $22K |
| RL MILSNER EIN 94-2494656 NONE | Insurance brokerage commissions and fees Service code 53 | — | $18K |
| BANK OF AMERICA EIN 94-1687665 NONE | Custodial (other than securities); Direct payment from the plan Service code 18 | — | $16K |
| PITNEY BOWES INC. EIN 06-0495050 NONE | Direct payment from the plan; Copying and duplicating Service code 36 | — | $13K |
| SEGAL BRYANT & HAMILL EIN 35-2679129 NONE | Investment management; Direct payment from the plan Service code 28 | — | $12K |
| PART D ADVISORS EIN 85-3689655 NONE | Other commissions; Consulting (general) Service code 16 | — | $9K |
| ADP NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | 600 CALIFORNIA STREET SAN FRANCISCO, CA 94108 | $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 | 1,141 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 218 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,359 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | BLUE SHIELD OF CALIFORNIA | 1,840 | $36.1M |
| Dental | DELTA DENTAL OF CALIFORNIA | 3,198 | $17K |
| Vision | VISION SERVICE PLAN | 1,259 | $418K |
| Life insurance(2 contracts, 2 carriers) | THE UNION LABOR LIFE INSURANCE CO. | 1,207 | $233K |
| Prescription drug | BLUE SHIELD OF CALIFORNIA | 1,840 | $22.1M |
| Other(2 contracts, 2 carriers) | THE UNION LABOR LIFE INSURANCE CO. | 1,207 | $233K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,198 | — |
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."
No prospect flags tripped on this filing.