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 |
|---|---|---|---|
| ANTHEM BLUE CROSS LIFE & HEALTH EIN 95-4331852 NONE | Claims processing; Other services; Contract Administrator; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $1.7M |
| DELTA DENTAL OF CALIFORNIA EIN 94-1461312 NONE | Plan Administrator; Claims processing Service code 12 | — | $362K |
| THE SEGAL COMPANY EIN 94-1503999 NONE | Actuarial; Consulting (general) Service code 11 | — | $351K |
| SEYFARTH SHAW LLP EIN 36-2152202 NONE | Legal Service code 29 | — | $317K |
| BLACKROCK INVESTMENT MANAGEMENT, LL EIN 20-5319476 NONE | Investment management fees paid directly by plan; Investment management; Direct payment from the plan Service code 28 | — | $188K |
| EXPRESS SCRIPTS, INC. EIN 22-3461740 NONE | Claims processing Service code 12 | — | $185K |
| CENTERSQUARE INVESTMENT MANAGEMENT, EIN 23-2817243 NONE | Investment management; Soft dollars commissions Service code 28 | — | $120K |
| EMPLOYEE 495 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $113K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $103K |
| EMPLOYEE 115 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $100K |
| GRANTHAM, MAYO, VANOTTERLOO & COMPA EIN 04-2691242 NONE | Investment management Service code 28 | — | $94K |
| MEDICAL REVIEW INSTITUTE OF AMERICA EIN 87-0515201 NONE | Consulting fees Service code 70 | — | $87K |
| EMPLOYEE 278 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $85K |
| EMPLOYEE 121 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $79K |
| VISION SERVICE PLAN-(CA) EIN 94-1632821 NONE | Claims processing Service code 12 | — | $72K |
| EMPLOYEE 176 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $67K |
| EMPLOYEE 195 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $66K |
| EMPLOYEE 160 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $65K |
| EMPLOYEE 501 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $64K |
| VITECH SYSTEMS GROUP, INC. EIN 13-3785492 NONE | Other services Service code 49 | — | $63K |
| EMPLOYEE 513 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $62K |
| EMPLOYEE 519 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $61K |
| EMPLOYEE 432 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $60K |
| EMPLOYEE 446 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $55K |
| EMPLOYEE 412 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $55K |
| EMPLOYEE 445 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $54K |
| EMPLOYEE 523 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $48K |
| LOOMIS-SAYLES GLOBAL FIXED INCOME EIN 04-3200030 NONE | Investment management fees paid directly by plan Service code 51 | — | $48K |
| EMPLOYEE 426 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $47K |
| LAQUER, URBAN, CLIFFORD & HODGE LLP EIN 95-4047729 NONE | Legal Service code 29 | — | $47K |
| EMPLOYEE 431 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $47K |
| EMPLOYEE 346 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $46K |
| EMPLOYEE 401 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $46K |
| EMPLOYEE 504 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $45K |
| EMPLOYEE 474 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $43K |
| EMPLOYEE 499 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $41K |
| EMPLOYEE 494 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $38K |
| EMPLOYEE 264 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $38K |
| EMPLOYEE 399 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $37K |
| JCK MEDICAL CORP EIN 46-2959965 NONE | Consulting (general) Service code 16 | — | $37K |
| EMPLOYEE 200 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $36K |
| CAL NET ENTERPRISES, LLC EIN 95-4751910 NONE | Consulting (general) Service code 16 | — | $33K |
| NIGRO, KARLIN & SEGAL & FELDSTEIN, EIN 95-3632775 NONE | Accounting (including auditing) Service code 10 | — | $33K |
| EMPLOYEE 197 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $32K |
| EMPLOYEE 502 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $31K |
| WELLINGTON MANAGEMENT COMPANY, LLP EIN 04-2755549 NONE | Investment management fees paid directly by plan Service code 51 | — | $29K |
| ROSSMORE PROPERTY & CASUALTY EIN 95-3658819 NONE | Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | — | $27K |
| PENSION CONSULTING ALLIANCE, LLC EIN 38-3863278 NONE | Consulting fees Service code 70 | — | $20K |
| IAPPSYS INC. EIN 20-2774279 NONE | Consulting (general) Service code 16 | — | $10K |
| WELLS FARGO EIN 94-3081343 NONE | Account maintenance fees Service code 65 | — | $8K |
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 | 6,798 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,163 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 7,961 | 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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.