2023 Form 5500 filing — Table Mountain Rancheria Welfare Benefit Plan
Plain-English filing summary
According to public Form 5500 filings published through the U.S. Department of Labor (DOL) Employee Benefits Security Administration (EBSA) via the EFAST2 system, this is the 2023 Form 5500 filing (EFAST2 acknowledgement 20240708074936NAL0025967234001) for Table Mountain Rancheria Welfare Benefit Plan, reported by Table Mountain Rancheria Band Of Indians under EIN 77-0212451 and plan number 501. It reports 998 participants. Attached schedules in the loaded dataset include Schedule C (service provider compensation).
- EFAST2 acknowledgement
- 20240708074936NAL0025967234001
- Filing year
- 2023
- Form type
- 2
- Plan sponsor
- Table Mountain Rancheria Band Of Indians
- EIN
- 77-0212451
- Plan number
- 501
- Location
- Friant, CA
- Participants
- 998
- Schedules available
- Schedule C
- Received date
- not reported in the loaded dataset
Reported financial snapshot (2023)
This 2023 filing is loaded, but detailed Schedule H/I financial figures are not present for it in the current loaded dataset. Participant counts and filing identity above are reported; asset and contribution detail comes from the financial schedules where filed.
Reported service provider compensation (Schedule C)
| Provider | Service | Direct comp. | Indirect comp. |
|---|---|---|---|
| Advantek | TPA | $297,906 | not reported in the loaded dataset |
| Anthem Blue Cross Life & Health | PPO NETWORK | $268,703 | not reported in the loaded dataset |
| Blue Cross Of California | PPO PANEL FEES | $219,316 | not reported in the loaded dataset |
| Multiplan | PPO REPRICING | $41,872 | not reported in the loaded dataset |
| Rxbenefits, Inc. | TPA | $12,799 | not reported in the loaded dataset |