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; Claims processing; Contract Administrator Service code 12 | P O BOX 31 MARTELL, CA 95654 | $1.2M |
| WELLS FARGO CLEARING SERVICES EIN 23-2384840 N / A | Securities brokerage; Investment advisory (plan); Investment management; Custodial (securities); Consulting (general); Direct payment from the plan Service code 16 | ONE NORTH JEFFERSON AVENUE ST. LOUIS, MO 63103 | $760K |
| WELLS FARGO BANK, N.A. EIN 94-1347373 N / A | Custodial (other than securities); Direct payment from the plan Service code 18 | P O BOX 6995 PORTLAND, OR 97228 | $94K |
| WEINTRAUB TOBIN CHEDIAK COLEMAN GRO EIN 68-0231351 N / A | Legal; Direct payment from the plan Service code 29 | 400 CAPITOL MALL 11TH FLOOR SACRAMENTO, CA 95814 | $70K |
| GREENBERG TRAURIG, LLP EIN 13-3613083 N / A | Consulting (general); Direct payment from the plan Service code 16 | 1201 K STREET STE 1100 SACRAMENTO, CA 95814 | $60K |
| UNITED HEALTH ACTUARIAL SERVICES EIN 04-3738148 N / A | Direct payment from the plan; Actuarial Service code 11 | 11611 NORTH MERIDIAN ST STE 330 CARMEL, IN 46032 | $48K |
| HEROIK MEDIA EIN 56-0891941 N / A | Direct payment from the plan; Other services Service code 49 | 412 DIXIE VIEW RD KNOXVILLE, TN 37934 | $30K |
| DENNIS CAMPANALE TRUSTEE & CO-CFO | Direct payment from the plan; Trustee (individual) Service code 20 | P O BOX 31 MARTELL, CA 95654 | $30K |
| RITA KERR N / A | Other services; Direct payment from the plan; Claims processing Service code 12 | 13591 PINE GULCH CT SUTTER CREEK, CA 95685 | $28K |
| ERICK MATTSON TRUSTEE & CHAIRMAN | Trustee (individual); Direct payment from the plan Service code 20 | P O BOX 31 MARTELL, CA 95654 | $20K |
| JOE CHIRILLO TRUSTEE & CO-CFO | Direct payment from the plan; Trustee (individual) Service code 20 | P O BOX 31 MARTELL, CA 95654 | $16K |
| EXAMONE WORLD WIDE EIN 23-5057350 N / A | Other services; Direct payment from the plan Service code 49 | P O BOX 201392 DALLAS, TX 73520 | $15K |
| MARIO YAGODA TRUSTEE | Trustee (individual); Direct payment from the plan Service code 20 | P O BOX 31 MARTELL, CA 95654 | $8K |
| GENE DANGEL TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | P O BOX 31 MARTELL, CA 95654 | $6K |
| KEVIN MICKELSON TRUSTEE | Trustee (individual); Direct payment from the plan Service code 20 | P O BOX 31 MARTELL, CA 95654 | $6K |
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 | 12,190 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 34 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 12,224 | 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.