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 |
|---|---|---|---|
| THE OPTION GROUP, LLC EIN 27-3721334 NONE | Other services; Participant communication; Direct payment from the plan Service code 38 | — | $413K |
| B BELL/P ROZELLE NFL PLAYER RET PL EIN 13-6043636 NONE | Other services; Direct payment from the plan Service code 49 | — | $227K |
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 NONE | Named fiduciary; Contract Administrator; Direct payment from the plan; Non-monetary compensation; Other services; Float revenue; Participant communication; Claims processing Service code 12 | — | $225K |
| GROOM LAW GROUP, CHARTERED EIN 52-1219029 NONE | Legal; Direct payment from the plan Service code 29 | — | $182K |
| RR DONNELLEY RECEIVABLES, INC. EIN 52-2125127 NONE | Direct payment from the plan; Copying and duplicating Service code 36 | — | $106K |
| THE BANK OF NEW YORK MELLON EIN 13-5160382 NONE | Direct payment from the plan; Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $51K |
| AON EIN 22-2232264 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $38K |
| MITCHELL & TITUS, LLP EIN 13-2781641 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $28K |
| CLOUDBERRY CREATIVE, INC. EIN 27-1271032 NONE | Direct payment from the plan; Consulting fees; Participant communication Service code 38 | — | $12K |
| MEDSTAR NATIONAL REHAB CENTER, INC. EIN 52-1369749 NONE | Other services; Direct payment from the plan Service code 49 | — | $10K |
| CYNTHIA ANN MUNRO NONE | Direct payment from the plan; Other services Service code 49 | 8 FAIRWOOD VIEW COURT PHOENIX, MD 21131 | $7K |
| LAURA DESADIER, D.O. EIN 47-3033331 NONE | Direct payment from the plan; Other services Service code 49 | — | $6K |
| SELENA ELLIS, M.D. EIN 20-2631373 NONE | Other services; Direct payment from the plan Service code 49 | — | $6K |
| LAUREN DRAG, PH.D. EIN 82-0726006 NONE | Other services; Direct payment from the plan Service code 49 | — | $5K |
| NICOLE WERNER, PH.D., LLC EIN 81-4319319 NONE | Direct payment from the plan; Other services Service code 49 | — | $5K |
| RODNEY D. VANDERPLOEG, PH.D. NONE | Other services; Direct payment from the plan Service code 49 | 111 2ND AVENUE NE SUITE 322 SAINT PETERSBURG, FL 33701 | $5K |
| UNIVERSITY PHYSICIANS, INC. EIN 74-2161737 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 | 1,590 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 297 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 10,741 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 12,628 | 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.