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 |
|---|---|---|---|
| SANDRA D. GAMBOA EIN 95-6289239 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 1168 E. LA CADENA DRIVE RIVERSIDE, CA 92507 | $175K |
| CARMEN MCKINLEY EIN 95-6289239 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 1168 E. LA CADENA DRIVE RIVERSIDE, CA 92507 | $156K |
| TINA L. CONNEEN EIN 95-6289239 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 1168 E. LA CADENA DRIVE RIVERSIDE, CA 92507 | $149K |
| SHERRI ANN RUBALCABA EIN 95-6289239 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | 1168 E. LA CADENA DRIVE RIVERSIDE, CA 92507 | $139K |
| PATTI JO MARTIN EIN 95-6289239 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 1168 E. LA CADENA DRIVE RIVERSIDE, CA 92507 | $133K |
| MARY CORONADO EIN 95-6289239 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | 1168 E. LA CADENA DRIVE RIVERSIDE, CA 92507 | $118K |
| SAVANNAH M. RUBALCABA EIN 95-6289239 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | 1168 E. LA CADENA DRIVE RIVERSIDE, CA 92507 | $116K |
| REICH, ADELL & CVITAN NONE | Legal; Direct payment from the plan Service code 29 | 3550 WILSHIRE BLVD, 2000 LOS ANGELES, CA 90010 | $21K |
| DUFFY, KRUSPODIN & COMPANY EIN 95-4244393 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $18K |
| OXFORD RISK MANAGEMENT & INSURANCE NONE | Direct payment from the plan; Consulting fees Service code 50 | 711 W CAMINO REAL ARCADIA, CA 91077 | $11K |
| KAVORINOS, ANTHONY DDS, APC NONE | Direct payment from the plan; Other services Service code 49 | 10630 TOWN CENTER DR. RANCHO CUCAMONGA, CA 91730 | $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 | 936 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 936 | 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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.