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 |
|---|---|---|---|
| YVONNE R. BAGAMAN EIN 95-1191130 EMPLOYEE | Employee (plan) Service code 30 | 17030 E COLIMA RD UNIT 110 HACIENDA HTS, CA 91745 | $141K |
| DUMAS & KIM EIN 95-3977828 CONTRACTOR | Legal Service code 29 | 3435 WILSHIRE BLVD 990 LOS ANGELES, CA 90010 | $124K |
| WELLS FARGO EIN 94-1347393 INVESTMENT ADVISOR | Investment management fees paid indirectly by plan Service code 52 | MAC E2076-021 PO BOX 20160 LONG BEACH, CA 90801 | $112K |
| WELLS FARGO 94-1347393 | Investment management fees paid indirectly by plan Service code 52 | — | $112K |
| IRON ROAD EIN 87-0427760 CONTRACTOR | Claims processing Service code 12 | 1040 N2200 W STE 200 SALT LAKE CITY, UT 84116 | $86K |
| HAYDEE MATA EIN 95-1191130 EMPLOYEE | Employee (plan) Service code 30 | 4689 FAIRBANKS AVE JURUPA VALLEY, CA 92509 | $80K |
| DIANA SEDANO EIN 95-1191130 EMPLOYEE | Employee (plan) Service code 30 | 567 ABERY AVE LA PUENTE, CA 91744 | $76K |
| CESAR P. CARRANCEJA CONTRACTOR | Accounting (including auditing) Service code 10 | 4810 CAREFREE DRIVE LAS VEGAS, NV 89122 | $54K |
| MCMENOMY & ASSOCIATES, CPAS, LLP EIN 46-1559312 CONTRACTOR | Accounting (including auditing) Service code 10 | 876 N MOUNTAIN AVE SUITE 105 UPLAND, CA 91786 | $28K |
| LARRY D PHILIPPI TRUSTEE | Trustee (individual) Service code 20 | PO BOX 2513 LAKE ARROWHEAD, CA 92352 | $19K |
| INFOCROSSING, LLC EIN 13-3252333 CONTRACTOR | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | 2 TOWER CENTER BLVD SUITE 2200 EAST BRUNSWICK, NJ 08816 | $17K |
| FIRST HEALTH GROUP CORP EIN 20-1736437 CONTRACTOR | Consulting (general) Service code 16 | 3200 HIGHLAND AVE DOWNERS GROVE, IL 60515 | $14K |
| KESSNER UMEBAYASHI BAIN & MATSUNAGA EIN 99-0176309 CONTRACTOR | Legal Service code 29 | 220 SOUTH KING ST 1900 HONOLULU, HI 96813 | $13K |
| CLIFFORD A REINHOLD EIN 94-6555763 CONTRACTOR | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | 15548 BRONCO DRIVE SANTA CLARITA, CA 91387 | $13K |
| STEPHEN T DAWSON TRUSTEE | Trustee (individual) Service code 20 | 5020 SEPULVEDA AVE SAN BERNARDINO, CA 92404 | $9K |
| CALIFORNIA DEPOSITION REPORTERS INC EIN 95-4168477 CONTRACTOR | Consulting (general) Service code 16 | 448 E FOOTHILL BLVD STE 101 SAN DIMAS, CA 91773 | $6K |
| SUSAN L. BENDIG EIN 52-8724498 CONTRACTOR | Accounting (including auditing) Service code 10 | 232 EAGLE WAY NORTH SALT LAKE, UT 84054 | $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 | 3 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 753 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 756 | 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.