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 |
|---|---|---|---|
| B BELL/P ROZELLE NFL PLAYER RET PL EIN 13-6043636 NONE | Direct payment from the plan; Other services Service code 49 | — | $493K |
| GROOM LAW GROUP EIN 52-1219029 NONE | Legal; Direct payment from the plan Service code 29 | — | $353K |
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 NONE | Named fiduciary; Claims processing; Direct payment from the plan; Non-monetary compensation; Float revenue; Participant communication; Other services; Contract Administrator Service code 12 | — | $167K |
| THE OPTION GROUP, LLC EIN 27-3721334 NONE | Other services; Participant communication; Direct payment from the plan Service code 38 | — | $126K |
| RR DONNELLEY RECEIVABLES, INC. EIN 52-2125127 NONE | Direct payment from the plan; Copying and duplicating Service code 36 | — | $77K |
| THE BANK OF NEW YORK MELLON EIN 13-5160382 NONE | Direct payment from the plan; Trustee (bank, trust company, or similar financial institution); Investment management fees paid directly by plan Service code 21 | — | $65K |
| ABRAMS, FOSTER, NOLE & WILLIAMS, PA EIN 52-1854049 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $28K |
| AON EIN 22-2232264 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $25K |
| RODNEY D. VANDERPLOEG, PH.D., ABPP NONE | Other services; Direct payment from the plan Service code 49 | 5322 PRIMROSE LAKE CIRCLE, SUITE G TAMPA, FL 33647 | $18K |
| NATIONAL REHABILITATION HOSPITAL EIN 52-1369749 NONE | Direct payment from the plan; Other services Service code 49 | — | $14K |
| DEAN C. DELIS, CLINICAL PSYCH, INC. EIN 81-0608729 NONE | Direct payment from the plan; Other services Service code 49 | — | $13K |
| CLOUDBERRY CREATIVE, INC. EIN 27-1271032 NONE | Participant communication; Direct payment from the plan; Consulting fees Service code 38 | — | $11K |
| FRANCISCO PEREZ, PH.D. & ASSOC. EIN 74-2178016 NONE | Other services; Direct payment from the plan Service code 49 | — | $10K |
| SUTAPA MCNASBY NONE | Direct payment from the plan; Other services Service code 49 | 4703 CARLTON CROSSING DRIVE DURHAM, NC 27713 | $9K |
| EDWARD J. O'CONNOR, M.D., FAAN EIN 20-0579634 NONE | Other services; Direct payment from the plan Service code 49 | — | $6K |
| UT SOUTHWESTERN MEDICAL CENTER EIN 75-6002868 NONE | Other services; Direct payment from the plan Service code 49 | — | $6K |
| ALAN R. BREEN PH.D., PLLC EIN 81-1924765 NONE | Other services; Direct payment from the plan Service code 49 | — | $5K |
| ATLANTA NEUROPSYCHOLOGY, LLC EIN 46-1232782 NONE | Other services; Direct payment from the plan Service code 49 | — | $5K |
| PATTON PSYCHOLOGY ASSOCIATES, INC. EIN 20-2000235 NONE | Other services; Direct payment from the plan Service code 49 | — | $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 | 1,381 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 279 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 9,766 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 11,426 | 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.