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 |
|---|---|---|---|
| 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 | — | $315K |
| B BELL/P ROZELLE NFL PLAYER RET PL EIN 13-6043636 NONE | Direct payment from the plan; Other services Service code 49 | — | $274K |
| PNC CAPITAL ADVISORS, LLC EIN 27-0640560 NONE | Investment advisory (plan); Investment management fees paid directly by plan; Investment management; Soft dollars commissions Service code 27 | — | $243K |
| AON EIN 22-2232264 NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Consulting (general); Actuarial Service code 11 | — | $237K |
| GROOM LAW GROUP EIN 52-1219029 NONE | Legal; Direct payment from the plan Service code 29 | — | $160K |
| RR DONNELLEY RECEIVABLES, INC. EIN 52-2125127 NONE | Copying and duplicating; Direct payment from the plan Service code 36 | — | $42K |
| THE BANK OF NEW YORK MELLON EIN 13-5160382 NONE | Trustee (bank, trust company, or similar financial institution); Shareholder servicing fees; Float revenue; Direct payment from the plan Service code 21 | — | $42K |
| ABRAMS, FOSTER, NOLE & WILLIAMS, PA EIN 52-1854049 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $26K |
| THE GAUDA GROUP LLC EIN 47-1700662 NONE | Direct payment from the plan; Other services Service code 49 | — | $8K |
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 | 2,235 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,629 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1,587 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 5,451 | 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.