Filings through .
History & trajectory Charts need 2 or more years. This plan has 10 years on file. Pro shows premium, premium per covered life, covered lives and carrier and broker share for every year.
See pricingNo prospect flags tripped on this filing.
The Schedule A insurance contracts show who carries the risk, for which benefits and for how many people.
No insurance carriers on this filing. Self-funded health and benefits plans typically pay TPAs and PBMs through Schedule C, not Schedule A.
These benefits are declared on the Form 5500 main form. A ✓ means the benefit also has a Schedule A insurance contract. Without one, plan assets or a Schedule C TPA fund the benefit.
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 473 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 170 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 278 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 921 | Active, retired or separated, and beneficiaries. Dependents are not counted. |
This filing has no Schedule A insurance contracts. This is typical of fully self-funded plans. 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 instead of this filer's headcount. We show the row, but it does not count the people in this plan.
Brokers paid through Schedule A and service providers paid through Schedule C.
No brokers reported on this filing.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BEACON ADMINISTRATORS & CONSULTANTS EIN 83-1544721 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $124K |
| COHEN WEISS AND SIMON, LLP EIN 13-1592323 NONE | Legal; Direct payment from the plan Service code 29 | — | $102K |
| PRINCIPAL EIN 94-1347393 NONE | Investment management fees paid directly by plan; Other fees; Investment management Service code 28 | — | $36K |
| MORGAN STANLEY SMITH BARNEY EIN 11-2418191 NONE | Investment advisory (plan); Investment management fees paid directly by plan Service code 27 | — | $35K |
| CHEVY CHASE TRUST COMPANY EIN 52-2037618 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | — | $30K |
| NOVAK FRANCELLA, LLC EIN 61-1436956 NONE | Accounting (including auditing) Service code 10 | — | $28K |
| FOSTER & FOSTER EIN 59-1921114 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $25K |
| XPAN LAW PARTNERS LLC NONE | Consulting (general); Direct payment from the plan Service code 16 | 4 N MAPLE AVE MARLTON, NJ 08053 | $19K |
| DANA INVESTMENT ADVISORS NONE | Investment advisory (plan); Investment management fees paid indirectly by plan Service code 27 | 20700 SWENSON DR. 400 WAUKESHA, WI 53186 | $16K |
| MORGAN LEWIS & BOCKIUS, LLP EIN 23-0891050 NONE | Legal; Direct payment from the plan Service code 29 | — | $11K |
This section shows how the plan is funded and what that means for risk.
Welfare charges, retention and retention rate (the carrier margin on this plan) are on Pro.
2 contacts
10 filings · 2016 to 2025