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 |
|---|---|---|---|
| LIFETIME BENEFIT SOLUTIONS, INC. EIN 16-1171765 NONE | Contract Administrator; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 12 | — | $708K |
| CORPORATE CARE MANAGEMENT EIN 16-1181119 NONE | Other services; Direct payment from the plan Service code 49 | — | $626K |
| PRIVATE HEALTHCARE SYSTEMS EIN 13-3068979 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $410K |
| SEI INVESTMENT MANAGEMENT CORP. EIN 23-1707341 INVESTMENT MANAGER | Investment management; Investment management fees paid directly by plan; Investment management fees paid indirectly by plan Service code 28 | — | $308K |
| JOSEPH W. MCCARTHY & ASSOCIATES EIN 16-1120588 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $191K |
| AETNA EIN 06-6033492 NONE | Claims processing; Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator Service code 12 | — | $167K |
| DEBORAH SPAULDING EIN 15-0582931 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $132K |
| SLEVIN & HART, P.C. EIN 52-1708613 ATTORNEY | Legal; Direct payment from the plan Service code 29 | — | $106K |
| CHRISTINE FIACCO EIN 15-0582931 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $99K |
| DEBORAH REINHARDT EIN 15-0582931 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $89K |
| SCHULTHEIS & PANETTIERI, LLP EIN 13-1577780 AUDITOR | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $77K |
| LAURIE FREDETTE EIN 15-0582931 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $77K |
| NOVA HEALTHCARE ADMINISTRATORS, INC EIN 16-6443379 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Claims processing Service code 12 | — | $74K |
| NINA NICHOLSON EIN 15-0582931 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $74K |
| CHRISTINE NASIATKA EIN 15-0582931 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $72K |
| SARAH QUINN EIN 15-0582931 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $64K |
| KELLEY HARRIGAN EIN 15-0582931 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $64K |
| BLITMAN & KING, LLP EIN 16-1047304 ATTORNEY | Legal; Direct payment from the plan Service code 29 | — | $59K |
| JENNIFER MCCORD EIN 15-0582931 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $56K |
| KELLIE ELLSWORTH EIN 15-0582931 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $56K |
| PEGEEN JACKSON EIN 15-0582931 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $49K |
| APRIL MCCORD EIN 15-0582931 NONE | Direct payment from the plan; Employee (plan) Service code 30 | — | $48K |
| JENNIFER KNOX EIN 15-0582931 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $48K |
| COURTNEY EVANS EIN 15-0582931 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $43K |
| DELTA DENTAL OF NY INC. EIN 11-1980218 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $43K |
| BOLTON PARTNERS, NE, INC. EIN 27-3666661 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $40K |
| PATRICIA REITZ EIN 15-0582931 NONE | Employee (plan); Direct payment from the plan Service code 30 | — | $40K |
| THE SEGAL GROUP, INC. EIN 06-0839113 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $32K |
| JP MORGAN CHASE BANK, NA EIN 13-4994650 NONE | Direct payment from the plan; Other services; Float revenue Service code 49 | — | $27K |
| AP BENEFIT ADVISORS, LLC EIN 30-0837157 NONE | Other services; Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | — | $17K |
| WELLS FARGO BANK, NA EIN 94-1347393 NONE | Custodial (securities); Investment management fees paid indirectly by plan; Investment management fees paid directly by plan; Shareholder servicing fees Service code 19 | — | $14K |
| DAVIS VISION EIN 11-3051991 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $9K |
| UPSTATE ADVISORS GROUP EIN 16-1540179 NONE | Direct payment from the plan; Investment advisory (plan) Service code 27 | — | $7K |
| LAWLEY SERVICE INC. EIN 16-0802517 NONE | Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | — | $6K |
| ENV INSURANCE AGENCY, LLC NONE | Insurance agents and brokers; Insurance brokerage commissions and fees; Other services Service code 22 | 7789 OSWEGO RD LIVERPOOL, NY 13090 | $2K |
| OPTUMRX, INC EIN 33-0441200 NONE | Other fees Service code 99 | — | $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 | 2,123 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 631 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 2,754 | 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.