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 | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Claims processing Service code 12 | — | $1.3M |
| WELLS FARGO CLEARING SERVICES LLC EIN 23-2384840 N/A | Investment advisory (plan); Direct payment from the plan; Custodial (securities) Service code 19 | — | $889K |
| LEACOX CALIFORNIA GOVERNMENTAL ADVO EIN 86-2573260 N/A | Direct payment from the plan; Consulting (general) Service code 16 | — | $135K |
| RISK STRATEGIES CONSULTING EIN 04-3738148 N/A | Direct payment from the plan; Actuarial Service code 11 | — | $131K |
| WELLS FARGO BANK, N.A. EIN 94-1347373 | Direct payment from the plan; Custodial (other than securities) Service code 18 | — | $118K |
| HEROIK MEDIA EIN 56-0891941 N/A | Other services; Direct payment from the plan Service code 49 | — | $75K |
| WEINTRAUB TOBIN CHEDIAK COLEMAN GRO EIN 68-0231351 N/A | Legal; Direct payment from the plan Service code 29 | — | $61K |
| MOSS ADAMS LLP EIN 91-0189318 N/A | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $58K |
| EXAMONE WORLD WIDE EIN 23-2057350 N/A | Direct payment from the plan; Other services Service code 49 | — | $38K |
| RITA KERR (MEDICAL DIRECTOR) EIN 38-8866810 N/A | Other services; Direct payment from the plan; Claims processing Service code 12 | — | $33K |
| DENNIS CAMPANALE TRUSTEE & CO-CFO | Trustee (individual); Direct payment from the plan Service code 20 | 255 SCOTTSVILLE BLVD JACKSON, CA 95642 | $31K |
| ERICK MATTSON TRUSTEE & CO-CHAIR | Trustee (individual); Direct payment from the plan Service code 20 | 255 SCOTTSVILLE BLVD JACKSON, CA 95642 | $29K |
| RED 88 MEDIA EIN 47-4987717 N/A | Other services; Direct payment from the plan Service code 49 | — | $27K |
| DARIN RYBURN TRUSTEE | Trustee (individual); Direct payment from the plan Service code 20 | 255 SCOTTSVILLE BLVD JACKSON, CA 95642 | $24K |
| REDLBL, LLC EIN 88-2769742 N/A | Other services; Direct payment from the plan Service code 49 | — | $23K |
| COMMERCE PRINTING SERVICES EIN 68-0168958 N/A | Copying and duplicating; Direct payment from the plan Service code 36 | — | $22K |
| CALIFORNIA ISSUES FORUM EIN 01-0595129 N/A | Consulting (general); Direct payment from the plan Service code 16 | — | $15K |
| JERRY HALL TRUSTEE | Trustee (individual); Direct payment from the plan Service code 20 | 255 SCOTTSVILLE BLVD JACKSON, CA 95642 | $6K |
| AIMEE NEW TRUSTEE | Trustee (individual); Direct payment from the plan Service code 20 | 255 SCOTTSVILLE BLVD JACKSON, CA 95642 | $6K |
| STEVE L. SANDEFER TRUSTEE | Trustee (individual); Direct payment from the plan Service code 20 | 255 SCOTTSVILLE BLVD JACKSON, CA 95642 | $5K |
| NICK FARACLAS TRUSTEE & CO-SECRETARY | Trustee (individual); Direct payment from the plan Service code 20 | 255 SCOTTSVILLE BLVD JACKSON, CA 95642 | $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 | 12,103 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 61 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 12,164 | 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.