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 |
|---|---|---|---|
| SAICHEK LAW FIRM APC EIN 26-0806256 NONE | Legal Service code 29 | 2445 FIFTH AVENUE, SUITE 332 SAN DIEGO, CA 92101 | $29K |
| DELTA HEALTH SYSTEMS EIN 94-2353289 NONE | Plan Administrator Service code 14 | P.O. BOX 1227 STOCKTON, CA 95201 | $18K |
| BERNARD KOTKIN & CO., LLP EIN 95-2556670 NONE | Accounting (including auditing) Service code 10 | 533 SOUTH FREMONT AVENUE SUITE 802 LOS ANGELES, CA 90071 | $7K |
| CHEIRON EIN 52-1659394 NONE | Actuarial Service code 11 | 1001 CONNECTICUT AVE NW, SUITE 315 WASHINGTON, DC 20036 | $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 | 148 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 87 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 10 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 1 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 245 | 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.