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 |
|---|---|---|---|
| CAPITAL ADVANTAGE ASSURANCE COMPANY EIN 45-5492167 NONE | Claims processing; Plan Administrator; Direct payment from the plan Service code 12 | — | $412K |
| DELTA DENTAL EIN 23-1667011 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $32K |
| BRAVO WELLNESS, LLC EIN 90-0414064 NONE | Other services; Direct payment from the plan Service code 49 | — | $22K |
| NATIONAL VISION ADMINISTRATORS EIN 74-3033381 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $7K |
| TOTAL ADMINISTRATIVE SERVICES CORP EIN 39-1561025 NONE | Plan Administrator; Claims processing; Direct payment from the plan Service code 12 | — | $7K |
| TROUT EBERSOLE & GROFF LLP EIN 23-1551315 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $6K |
| EXPRESS SCRIPTS, INC. EIN 43-1420563 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $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 | 508 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 85 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 593 | 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.