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 | Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Direct payment from the plan Service code 12 | — | $1.2M |
| WELLS FARGO CLEARING SERVICES EIN 23-2384840 N/A | Consulting (general); Custodial (securities); Direct payment from the plan; Securities brokerage; Investment management; Investment advisory (plan) Service code 16 | — | $869K |
| HEROIK MEDIA EIN 56-0891941 N/A | Other services; Direct payment from the plan Service code 49 | — | $129K |
| UNITED HEALTH ACTUARIAL SERVICES EIN 04-3738148 N/A | Direct payment from the plan; Actuarial Service code 11 | — | $109K |
| WELLS FARGO BANK, N.A. EIN 94-1347373 N/A | Direct payment from the plan; Custodial (other than securities) Service code 18 | — | $104K |
| WEINTRAUB TOBIN CHEDIAK COLEMAN GRO EIN 68-0231351 N/A | Legal; Direct payment from the plan Service code 29 | — | $76K |
| MOSS ADAMS LLP EIN 91-0189318 N/A | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $72K |
| DENNIS CAMPANALE TRUSTEE & CFO | Direct payment from the plan; Trustee (individual) Service code 20 | 255 SCOTTSVILLE BLVD JACKSON, CA 95642 | $33K |
| RITA KERR N/A | Claims processing; Other services; Direct payment from the plan Service code 12 | 13591 PINE GULCH CT SUTTER CREEK, CA 95685 | $27K |
| DARIN RYBURN TRUSTEE | Trustee (individual); Direct payment from the plan Service code 20 | 255 SCOTTSVILLE BLVD JACKSON, CA 95642 | $24K |
| ERICK MATTSON TRUSTEE & CHAIRMAN | Trustee (individual); Direct payment from the plan Service code 20 | 255 SCOTTSVILLE BLVD JACKSON, CA 95642 | $22K |
| EXAMONE WORLD WIDE EIN 23-5057350 N/A | Other services; Direct payment from the plan Service code 49 | — | $13K |
| JOE CHIRILLO TRUSTEE & CFO | Direct payment from the plan; Trustee (individual) Service code 20 | 255 SCOTTSVILLE BLVD JACKSON, CA 95642 | $7K |
| STEVE L. SANDEFER TRUSTEE | Trustee (individual); Direct payment from the plan Service code 20 | 255 SCOTTSVILLE BLVD JACKSON, CA 95642 | $7K |
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 | 49 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 12,152 | 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.