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 | — | $302K |
| GROOM LAW GROUP EIN 52-1219029 NONE | Legal; Direct payment from the plan Service code 29 | — | $230K |
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 NONE | Contract Administrator; Non-monetary compensation; Direct payment from the plan; Other services; Claims processing; Named fiduciary; Participant communication; Float revenue Service code 12 | — | $173K |
| THE OPTION GROUP, LLC EIN 27-3721334 NONE | Other services; Direct payment from the plan; Participant communication Service code 38 | — | $152K |
| THE BANK OF NEW YORK MELLON EIN 13-5160382 NONE | Trustee (bank, trust company, or similar financial institution); Direct payment from the plan Service code 21 | — | $63K |
| AON EIN 22-2232264 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $29K |
| ABRAMS, FOSTER, NOLE & WILLIAMS, PA EIN 52-1854049 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $28K |
| RR DONNELLEY RECEIVABLES, INC. EIN 52-2125127 NONE | Copying and duplicating; Direct payment from the plan Service code 36 | — | $15K |
| FRANCISCO PEREZ, PH.D. & ASSOC. EIN 74-2178016 NONE | Other services; Direct payment from the plan Service code 49 | — | $10K |
| ROWANSOM NEW JERSEY INSTITUTE EIN 22-3615875 NONE | Direct payment from the plan; Other services Service code 49 | — | $10K |
| UNIVERSITY PHYSICIANS, INC. EIN 74-2161737 NONE | Other services; Direct payment from the plan Service code 49 | — | $8K |
| CYNTHIA ANN MUNRO NONE | Other services; Direct payment from the plan Service code 49 | 8 FARIWOOD VIEW COURT PHOENIX, MD 21131 | $8K |
| BARRY J. MCCASLAND M.D., P.C. EIN 58-1318583 NONE | Direct payment from the plan; Other services Service code 49 | — | $7K |
| ATLANTA NEUROPSYCHOLOGY, LLC EIN 46-1232782 NONE | Other services; Direct payment from the plan Service code 49 | — | $5K |
| ROBERT L. HEILBRONNER, PH.D NONE | Direct payment from the plan; Other services Service code 49 | 333 N. MICHIGAN AVENUE SUITE 1801 CHICAGO, IL 60601 | $5K |
| UT SOUTHWESTERN MEDICAL CENTER EIN 75-6002868 NONE | Direct payment from the plan; Other services 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 | 1,390 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 281 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 9,964 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 11,635 | 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.