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 |
|---|---|---|---|
| OPTUM RX, INC. EIN 33-0441200 NONE | Float revenue; Claims processing; Other fees; Direct payment from the plan Service code 12 | — | $830K |
| UNION LABOR LIFE INSURANCE NONE | Insurance services; Direct payment from the plan Service code 23 | 8403 COLESVILLE RD SILVER SPRING, MD 20910 | $302K |
| EXCELLUS BLUECROSS BLUESHIELD EIN 16-0821557 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $275K |
| BLITMAN & KING EIN 16-1047304 NONE | Direct payment from the plan; Legal Service code 29 | — | $122K |
| SEGAL COMPANY EIN 13-1835864 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $93K |
| JOSEPH MCCARTHY EIN 16-1120588 PAYROLL AUDITOR | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $78K |
| MELISSA DEL PRETE EIN 16-0821557 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $66K |
| MORGANSTANLEY SMITHBARNEY LLC EIN 36-3145972 NONE | Other investment fees and expenses; Investment advisory (plan); Direct payment from the plan Service code 27 | — | $65K |
| ROCHESTER LABORERS BUILDING CORP AFFILIATED FUND | Other services; Direct payment from the plan Service code 49 | 20 FOURTH STREET ROCHESTER, NY 14609 | $50K |
| PATRICIA CALACI EIN 16-0821557 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $46K |
| JUSTIN VIBBER EIN 16-0871557 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $42K |
| BONADIO & CO., LLP EIN 16-1131146 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $40K |
| INNOVATIVE SOFTWARE SOLUTIONS, INC. NONE | Direct payment from the plan; Other services Service code 49 | 3000 SOUTH LENOLA ROAD MAPLE SHADE, NJ 08052 | $36K |
| MELISSA WHITE EIN 16-0821557 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $33K |
| MARY ANN COPELAND EIN 16-0821557 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $30K |
| STEVEN OSTRANDER EIN 16-0821557 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $28K |
| DONNA LEWIS EIN 16-0821557 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $25K |
| THE HARTFORD NONE | Insurance agents and brokers; Direct payment from the plan Service code 22 | 690 ASLYM AVENUE HARTFORD, CT 06155 | $24K |
| SYSTEMS OF NY NONE | Other services; Direct payment from the plan Service code 49 | 45 EAST AVENUE FLOOR 3 ROCHESTER, NY 14604 | $16K |
| QUADIENT FINANCE, USA NONE | Other services; Direct payment from the plan Service code 49 | 478 WHEELERS FARMS ROAD MILFORD, CT 06461 | $11K |
| DELTA SQUARE, INC. NONE | Other services; Direct payment from the plan Service code 49 | 2712 E HENRIETTA ROAD HENRIETTA, NY 14467 | $9K |
| MANNING & NAPIER INC. EIN 16-0995763 NONE | Investment management fees paid directly by plan; Investment management Service code 28 | — | $6K |
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 | 669 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 669 | 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.