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 | Float revenue; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Other services Service code 12 | — | $1.9M |
| DELTA DENTAL OF CALIFORNIA EIN 94-1461312 NONE | Direct payment from the plan; Claims processing; Plan Administrator Service code 12 | — | $379K |
| THE SEGAL COMPANY EIN 94-1503999 NONE | Actuarial; Consulting (general) Service code 11 | — | $328K |
| SEYFARTH SHAW LLP EIN 36-2152202 NONE | Legal Service code 29 | — | $273K |
| BLACKROCK INVESTMENT MGMT, LLC EIN 20-5319476 NONE | Investment management fees paid directly by plan; Investment management; Direct payment from the plan Service code 28 | — | $202K |
| EXPRESS SCRIPTS, INC. EIN 22-3461740 NONE | Claims processing Service code 12 | — | $152K |
| CENTERSQUARE INVESTMENT MGMT, INC. EIN 23-2817243 NONE | Investment management; Soft dollars commissions Service code 28 | — | $135K |
| STATE STREET BANK AND TRUST EIN 04-1867445 NONE | Custodial (securities) Service code 19 | — | $126K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $119K |
| EMPLOYEE 495 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $113K |
| GRANTHAM MAYO VANOTTERLOO & CO LLC EIN 02-0648221 NONE | Investment management Service code 28 | — | $111K |
| EMPLOYEE 115 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $107K |
| MEDICAL REVIEW INSTITUTE OF AMERICA EIN 87-0515201 NONE | Consulting fees Service code 70 | — | $99K |
| EMPLOYEE 278 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $88K |
| EMPLOYEE 121 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $79K |
| VISION SERVICE PLAN -(CA) EIN 94-1632821 NONE | Insurance services Service code 23 | — | $72K |
| EMPLOYEE 195 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $71K |
| EMPLOYEE 534 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $69K |
| EMPLOYEE 513 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $68K |
| EMPLOYEE 176 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $65K |
| EMPLOYEE 519 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $65K |
| EMPLOYEE 432 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $62K |
| VITECH SYSTEMS GROUP, INC. EIN 13-3785492 NONE | Other services Service code 49 | — | $60K |
| EMPLOYEE 520 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $58K |
| EMPLOYEE 523 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $57K |
| EMPLOYEE 446 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $57K |
| EMPLOYEE 412 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $57K |
| EMPLOYEE 538 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $57K |
| LAQUER, URBAN, CLIFFORD & HODGE LLP EIN 95-4047729 NONE | Legal Service code 29 | — | $53K |
| EMPLOYEE 426 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $52K |
| EMPLOYEE 346 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $49K |
| EMPLOYEE 504 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $49K |
| EMPLOYEE 431 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $48K |
| EMPLOYEE 401 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $48K |
| EMPLOYEE 200 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $45K |
| EMPLOYEE 264 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $45K |
| EMPLOYEE 474 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $44K |
| EMPLOYEE 543 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $43K |
| EMPLOYEE 499 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $43K |
| EMPLOYEE 399 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $38K |
| EMPLOYEE 544 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $36K |
| JCK MEDICAL CORP EIN 46-2959965 NONE | Consulting (general) Service code 16 | — | $36K |
| EMPLOYEE 197 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $33K |
| CAL NET ENTERPRISES, LLC EIN 95-4751910 NONE | Consulting (general) Service code 16 | — | $33K |
| EMPLOYEE 541 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $28K |
| WELLS FARGO EIN 94-3081343 NONE | Account maintenance fees Service code 65 | — | $26K |
| PENSION CONSULTING ALLIANCE, LLC EIN 38-3863278 NONE | Consulting fees; Investment advisory (plan) Service code 27 | — | $24K |
| SEGAL SELECT INSURANCE SERVICES INC EIN 46-0619194 NONE | Insurance brokerage commissions and fees Service code 53 | — | $22K |
| NIGRO KARLIN & SEGAL & FELDSTEIN EIN 95-3632775 NONE | Accounting (including auditing) Service code 10 | — | $19K |
| STATE STREET GLOBAL ADVISOR TR CO EIN 81-4017137 NONE | Custodial (other than securities); Investment management fees paid directly by plan; Custodial (securities) Service code 18 | — | $12K |
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 | 7,105 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,204 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 8,309 | 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.