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 |
|---|---|---|---|
| RIZZI SCHWARZ & TARASKAS, LLP EIN 11-3084306 ACCOUNTANT | Accounting (including auditing) Service code 10 | — | $18K |
| MERRILL LYNCH EIN 13-5674085 INVESTMENT ADVISOR | Investment advisory (plan) Service code 27 | — | $11K |
| MASSACHUSETTS MUTUAL LIFE INS. CO. EIN 04-1590850 CONTRACT ADMINISTRATOR | Direct payment from the plan; Investment management fees paid indirectly by plan; Sub-transfer agency fees; Other services; Recordkeeping fees; Other fees; Insurance services; Distribution (12b-1) fees; Other commissions; Account maintenance fees; Shareholder servicing fees; Sales loads (front end and deferred); Other investment fees and expenses; Participant loan processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Participant communication; Insurance mortality and expense charge Service code 15 | — | $10K |
| MESIROW FINANCIAL INVEST MGMT, INC | Other services Service code 49 | — | $22 |
| AMERICAN FUNDS EIN 95-2817150 INVESTMENT PROVIDER | Investment management fees paid indirectly by plan Service code 52 | — | $0 |
| BLACKROCK EIN 51-0318674 INVESTMENT PROVIDER | Investment management fees paid indirectly by plan Service code 52 | — | $0 |
| EATON VANCE EIN 04-2325690 INVESTMENT PROVIDER | Investment management fees paid indirectly by plan Service code 52 | — | $0 |
| MASS MUTUAL LIFE INSURANCE COMPANY | Investment management fees paid indirectly by plan; Shareholder servicing fees; Distribution (12b-1) fees; Float revenue; Sub-transfer agency fees Service code 52 | — | $0 |
| MASSACHUSETTS MUTUAL LIFE INS CO | Other services Service code 49 | — | $0 |
| MESIROW FINANCIAL INVEST MGMT EIN 36-3429599 N/A | Other services Service code 49 | — | $0 |
| MFS INVESTMENT MANAGEMENT EIN 04-3158862 INVESTMENT PROVIDER | Investment management fees paid indirectly by plan Service code 52 | — | $0 |
| PGIM INVESTMENTS EIN 13-3040042 INVESTMENT PROVIDER | Investment management fees paid indirectly by plan Service code 52 | — | $0 |
| WELLS FARGO EIN 41-0449260 INVESTMENT PROVIDER | Investment management fees paid indirectly by plan Service code 52 | — | $0 |
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 | 137 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 22 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 160 | 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.