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History & trajectory Charts need 2 or more years. This plan has 9 years on file. Pro shows premium, premium per covered life, covered lives and carrier and broker share for every year.
See pricingThe plan is self-funded and has no stop-loss carrier. A large claim hits the plan directly. Stop-loss carriers can pitch it.
The Schedule A insurance contracts show who carries the risk, for which benefits and for how many people.
No insurance carriers on this filing. Self-funded health and benefits plans typically pay TPAs and PBMs through Schedule C, not Schedule A.
These benefits are declared on the Form 5500 main form. A ✓ means the benefit also has a Schedule A insurance contract. Without one, plan assets or a Schedule C TPA fund the benefit.
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 18,753 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 94 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 18,847 | Active, retired or separated, and beneficiaries. Dependents are not counted. |
This filing has no Schedule A insurance contracts. This is typical of fully self-funded plans. 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 instead of this filer's headcount. We show the row, but it does not count the people in this plan.
Brokers paid through Schedule A and service providers paid through Schedule C.
No brokers reported on this filing.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CA PUBLIC SAFETY ADMINISTRATORS EIN 47-2562237 N/A | Claims processing; Contract Administrator; Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $1.1M |
| WEINTRAUB TOBIN CHEDIAK COLEMAN GRO EIN 68-0231351 N/A | Legal; Direct payment from the plan Service code 29 | — | $70K |
| WELLS FARGO CLEARING SERVICES, LLC EIN 23-2384840 N/A | Direct payment from the plan; Custodial (securities); Investment advisory (plan) Service code 19 | — | $58K |
| RISK STRATEGIES CONSULTING EIN 04-3738148 N/A | Direct payment from the plan; Actuarial Service code 11 | — | $45K |
| MOSS ADAMS LLP EIN 91-0189318 N/A | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $45K |
| HEROIK MEDIA EIN 56-0891941 N/A | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $15K |
| RITA KERR (MEDICAL DIRECTOR) EIN 38-8866810 N/A | Other services; Direct payment from the plan; Claims processing Service code 12 | — | $15K |
| ERICK MATTSON TRUSTEE & PRESIDENT | Trustee (individual); Direct payment from the plan Service code 20 | 255 SCOTTSVILLE BLVD JACKSON, CA 95642 | $12K |
| DENNIS CAMPANALE TRUSTEE & CFO | Direct payment from the plan; Trustee (individual) Service code 20 | 255 SCOTTSVILLE BLVD JACKSON, CA 95642 | $9K |
| AIMEE NEW TRUSTEE & VP | Trustee (individual); Direct payment from the plan Service code 20 | 255 SCOTTSVILLE BLVD JACKSON, CA 95642 | $8K |
| NICK FARACLAS TRUSTEE & SECRETARY | Direct payment from the plan; Trustee (individual) Service code 20 | 255 SCOTTSVILLE BLVD JACKSON, CA 95642 | $8K |
| STEVE SANDEFER TRUSTEE & VP | Trustee (individual); Direct payment from the plan Service code 20 | 255 SCOTTSVILLE BLVD JACKSON, CA 95642 | $7K |
| WELLS FARGO BANK, N.A. EIN 94-1347373 N/A | Direct payment from the plan; Custodial (other than securities) Service code 18 | — | $6K |
This section shows how the plan is funded and what that means for risk.
Welfare charges, retention and retention rate (the carrier margin on this plan) are on Pro.
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9 filings · 2016 to 2024