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 |
|---|---|---|---|
| STEVEN LUTZ EIN 23-1919421 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $246K |
| STEVEN KUNCELMAN EIN 23-1919421 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $231K |
| DIANE DELLO BUONO EIN 23-1919421 EMPLOYEE | Direct payment from the plan; Employee (plan) Service code 30 | — | $137K |
| LESLIE GABLE EIN 23-1919421 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $129K |
| PARTNERS IN SAFETY EIN 14-1761532 NONE | Other services; Direct payment from the plan Service code 49 | — | $120K |
| M3 INFORMATION TECHNOLOGY SOLUTIONS NONE | Direct payment from the plan; Consulting (general) Service code 16 | 213 SPRING VIEW DRIVE DOUGLASVILLE, PA 19518 | $34K |
| NOVAK FRANCELLA LLC EIN 61-1436956 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $33K |
| IBEW LOCAL 126 EIN 23-1302203 RELATED PARTY | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 15 | — | $24K |
| CONCENTRA MEDICAL CENTER EIN 75-2014828 NONE | Other services; Direct payment from the plan Service code 49 | — | $20K |
| INDUSTRIAL TRAINING INTERNATIONAL EIN 91-1499151 NONE | Direct payment from the plan; Other services Service code 49 | — | $16K |
| R&K LANDSCAPING EIN 23-2839044 NONE | Direct payment from the plan; Other services Service code 49 | — | $15K |
| ADP SCREENING EIN 84-1028716 NONE | Other services; Direct payment from the plan Service code 49 | — | $13K |
| STRASSHEIM GRAPHIC DESIGN NONE | Other services; Direct payment from the plan Service code 49 | 1500 SPRING GARDEN STREET PHILADELPHIA, PA 19130 | $13K |
| RONALD M MOORE NONE | Other fees; Direct payment from the plan Service code 50 | 819 COUNTY RD 1175 MOUNTAIN HOME, AR 72653 | $11K |
| UBS FINANCIAL SERVICES, INC. EIN 13-2638166 NONE | Investment management fees paid directly by plan; Other fees Service code 51 | — | $10K |
| COYNE FIRST AID NONE | Other services; Direct payment from the plan Service code 49 | 916 PA-113 SELLERSVILLE, PA 18960 | $8K |
| DAYHILL GROUP NONE | Direct payment from the plan; Other services Service code 49 | 1205 WEST LAKES DR. SUITE 280 BERWYN, PA 19312 | $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 | 1,619 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1,619 | 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."
No prospect flags tripped on this filing.