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 | Employee (plan); Direct payment from the plan Service code 30 | — | $283K |
| NICHOLAS PRIGO LLC EIN 88-3180023 NONE | Direct payment from the plan; Other services Service code 49 | — | $250K |
| H&H GRAPHIC PRINTING COMMUNICATIONS EIN 27-0771521 NONE | Copying and duplicating; Direct payment from the plan Service code 36 | — | $241K |
| JAMES, WILLIAM EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $180K |
| BARRY, JAMES P EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $169K |
| BRACCIOLI, ADRIANA A EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $169K |
| THERING, TOM EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $147K |
| GAUTO, JULIO EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $139K |
| RAUCHER, GLENN MICHAEL EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $137K |
| GONZALEZ, JOSE EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $137K |
| PUERTA LOPEZ, JESUS JHONI EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $134K |
| ZAMBRANO LOPEZ, ANA EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $130K |
| RYAN, TY-JAMAR EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $126K |
| BOREN, MICHAELA V EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $126K |
| GUERRERO, JHOANNA EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $126K |
| BRUMLEY, STEVEN EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $125K |
| TRAVERS, JUDITH EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $124K |
| LUCAS, JASON EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $123K |
| DG3 NORTH AMERICA, INC. EIN 22-2478136 NONE | Other services; Direct payment from the plan Service code 49 | — | $123K |
| MARIN, ORLANDO EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $122K |
| ANDREWS, BENJAMIN EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $121K |
| WINGATE, DONALD EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $121K |
| CUNNINGHAM, JOSEPH EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $118K |
| RUEDA, LIBARDO EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $113K |
| LOZA, EFRAIN EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $112K |
| NATHANSON, ADAM EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $112K |
| DYER, TIMOTHY EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $111K |
| DORNIER, AMY ELIZABETH EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $111K |
| ORNDOFF, ROBERT EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $109K |
| JOSEPHS, SELINA EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $108K |
| NISIVOCCIA, RENEE EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $108K |
| CORTEZ, CARLOS EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $107K |
| ROLAND, JOSEPH P EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $105K |
| PHILLIP, AKIDA EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $101K |
| AGUILAR, VICTOR R EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $100K |
| SANTIAGO, THOMAS EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $97K |
| OSBORNE, MARGOT H EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $96K |
| GREEN, MICHAEL J EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $92K |
| MORTIMER, MICHAEL EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $91K |
| SEVERINO, YANIREL EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $91K |
| MORENO, GLENDA EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $90K |
| URENA, ANTHONY EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $88K |
| BRISTOL, EDUARDO EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $83K |
| MERCADO, RAQUEL EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $79K |
| CANTRES, EMMANUEL EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $76K |
| VEERAPATHRAN, GODWIN EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $71K |
| BARRAGAN RAMOS, DENIS EIN 23-7424757 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $70K |
| BERKELEY LTC EIN 20-8249939 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $69K |
| ADP, INC EIN 13-3036845 NONE | Other services; Direct payment from the plan Service code 49 | — | $60K |
| MEDINA, JOSE EIN 23-7424757 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $57K |
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 | 107,012 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,433 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 108,445 | 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.