No insurance carriers on this filing. Self-funded welfare plans typically pay TPAs and PBMs through Schedule C, not Schedule A.
No brokers reported on this filing.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| GOWELL-NELSON, LINDA EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $250K |
| H AND H GRAPHIC PRINTING COMMUNICAT EIN 06-1648637 NONE | Direct payment from the plan; Copying and duplicating Service code 36 | — | $180K |
| LEGGIO, JAMES EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $148K |
| BARRY, JAMES P EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $143K |
| PRIGO, NICHOLAS EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $135K |
| BRACCIOLI, ADRIANA ALEJANDRA EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $132K |
| GONZALEZ, JOSE EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $122K |
| MULDOON, ROBERT EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $120K |
| PUERTA-LOPEZ, JESUS JOHNI EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $119K |
| THERING, THOMAS EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $118K |
| THOMAS, TY-JAMAR RYAN EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $111K |
| BECERRA, JESUS EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $109K |
| ANDREWS, BENJAMIN EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $108K |
| GUERRERO, JHOANNA EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $104K |
| MEDINA, JOSE M EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $103K |
| WINGATE, DONALD EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $102K |
| GLEATON, ANDRE S EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $101K |
| MARIN, ORLANDO EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $99K |
| HARRIS, RICHARD EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $99K |
| MELENDEZ-BENSON, AMY EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $97K |
| RITTLE, KATY EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $97K |
| ROLAND, JOSEPH P EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $95K |
| CUNNINGHAM, JOSEPH EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $91K |
| RAMOS, AWILDA EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $90K |
| OLIVEIRA, ADRIANA A EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $88K |
| PUENTE, CAROLINA EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $88K |
| STOKES, ROBERT EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $87K |
| ORNDOFF, ROBERT EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $86K |
| OSBORNE, MARGOT H EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $85K |
| MENDELSOHN, ERIKA EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $81K |
| GAUTO, JULIO EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $81K |
| GLUKHOV, ALEXANDER EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $80K |
| BRUMLEY, STEVEN EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $79K |
| AGUILAR, VICTOR EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $78K |
| ROSA, JOSE A EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $77K |
| VELEZ, SONIA ROSA EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $75K |
| OLIVERA SR, VICTOR EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $72K |
| MORTIMER, MICHAEL EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $71K |
| MERCADO, RAQUEL EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $69K |
| MORENO, GLENDA EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $68K |
| OPEN SESAME EIN 45-1621241 NONE | Other services; Direct payment from the plan Service code 49 | — | $60K |
| FOBI, KENNETH EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $57K |
| BERKELEY LTC EIN 20-8249939 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $56K |
| CORTEZ, CARLOS EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $48K |
| ADP INC EIN 13-3036745 NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $48K |
| TERRY, FREDERICK C EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $47K |
| KEEFE, TIMOTHY EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $46K |
| COMO, MICHAEL EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $46K |
| BALOBIN, DENIS EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $45K |
| DENSON, ROBERT EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $45K |
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 | 92,163 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,278 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 93,441 | Active + retired/separated + beneficiaries. No dependents. |
No Schedule A insurance contracts on this filing — typical of fully self-funded plans, where the only headcount is the Form 5500 number above.
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.