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 |
|---|---|---|---|
| CA PUBLIC SAFETY ADMINISTRATORS EIN 47-2562237 N/A | Direct payment from the plan; Contract Administrator Service code 13 | P O BOX 31 MARTELL, CA 95654 | $913K |
| WEINTRAUB TOBIN CHEDIAK COLEMAN GRO EIN 68-0231351 N/A | Legal; Direct payment from the plan Service code 29 | 400 CAPITAL MALL 11TH FLOOR SACRAMENTO, CA 95814 | $67K |
| UNITED HEALTH ACTUARIAL SERVICES EIN 04-3738148 N/A | Actuarial; Direct payment from the plan Service code 11 | 11611 NORTH MERIDIAN STREET STE 330 CARMEL, IN 46032 | $36K |
| CAMPBELL TAYLOR WASHBURN EIN 68-0251243 N/A | Accounting (including auditing); Direct payment from the plan Service code 10 | 3741 DOUGLAS BLVD, SUITE 350 ROSEVILLE, CA 95661 | $24K |
| WELLS FARGO CLEARING SERVICES EIN 23-2384840 N/A | Investment advisory (plan); Custodial (securities); Direct payment from the plan Service code 19 | ONE NORTH JEFFERSON AVENUE SAINT LOUIS, MO 63103 | $20K |
| ERICK MATTSON TRUSTEE & PRESIDENT | Direct payment from the plan; Trustee (individual) Service code 20 | P O BOX 31 MARTELL, CA 95654 | $14K |
| RITA KERR N/A | Claims processing; Direct payment from the plan; Other services Service code 12 | 13591 PINE GULCH CT SUTTER CREEK, CA 95685 | $10K |
| CORPORATE COMPUTER CONSULTING EIN 55-8752544 N/A | Direct payment from the plan; Consulting (general) Service code 16 | P O BOX 1232 OAKDALE, CA 95361 | $9K |
| WELLS FARGO BANK, N.A. EIN 94-1347373 N/A | Direct payment from the plan; Custodial (other than securities) Service code 18 | P O BOX 6995 PORTLAND, OR 97228 | $9K |
| DENNIS CAMPANALE TRUSTEE & CFO | Direct payment from the plan; Trustee (individual) Service code 20 | P O BOX 31 MARTELL, CA 95654 | $9K |
| STEVE SANDEFER TRUSTEE & VP | Direct payment from the plan; Trustee (individual) Service code 20 | P O BOX 31 MARTELL, CA 95654 | $8K |
| AIMEE NEW TRUSTEE & VP | Trustee (individual); Direct payment from the plan Service code 20 | P O BOX 31 MARTELL, CA 95654 | $7K |
| NICK FARACLAS TRUSTEE & EX. SECRETARY | Trustee (individual); Direct payment from the plan Service code 20 | P O BOX 31 MARTELL, CA 95654 | $5K |
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 | 17,605 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 71 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 17,676 | 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."
Self-funded plan with no stop-loss carrier attached. Catastrophic-risk exposure; stop-loss specialist sales target.