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 AND HEALTH EIN 95-4331852 NONE | Other services; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | — | $2.2M |
| SEYFARTH SHAW LLP EIN 36-2152202 NONE | Legal Service code 29 | — | $455K |
| DELTA DENTAL OF CALIFORNIA EIN 94-1461312 NONE | Direct payment from the plan; Claims processing; Plan Administrator Service code 12 | — | $404K |
| THE SEGAL COMPANY(WESTERN STATES) EIN 94-1503999 NONE | Actuarial; Consulting (general) Service code 11 | — | $383K |
| EXPRESS SCRIPTS, INC. EIN 22-3461740 NONE | Claims processing Service code 12 | — | $333K |
| MEDICAL REVIEW INSTITUTE OF AMERICA EIN 87-0515201 NONE | Consulting fees Service code 70 | — | $291K |
| EMPLOYEE ID 115 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $218K |
| NIGRO KARLIN SEGAL FELDSTEIN & BOLN EIN 95-3632775 NONE | Accounting (including auditing) Service code 10 | — | $193K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $177K |
| EMPLOYEE ID 520 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $131K |
| SEGAL SELECT INSURANCE SERVICES INC EIN 46-0619194 NONE | Insurance brokerage commissions and fees Service code 53 | — | $128K |
| CENTERSQUARE INVESTMENT MGMT, LLC EIN 82-2740355 NONE | Investment management; Soft dollars commissions Service code 28 | — | $112K |
| BLACKROCK INVESTMENT MANAGEMENT,LLC EIN 20-5319476 NONE | Investment management fees paid directly by plan; Direct payment from the plan; Investment management Service code 28 | — | $111K |
| STEVEN M. SIMONS, M.D., INC. EIN 95-3524994 NONE | Consulting (general) Service code 16 | — | $98K |
| EMPLOYEE ID 278 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $93K |
| EMPLOYEE ID 121 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $89K |
| EMPLOYEE ID 538 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $83K |
| EMPLOYEE ID 534 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $83K |
| GRANTHAM,MAYO,VANOTTERLOO & CO LLC EIN 02-0648221 NONE | Investment management Service code 28 | — | $81K |
| EMPLOYEE ID 195 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $78K |
| EMPLOYEE ID 200 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $77K |
| EMPLOYEE ID 513 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $77K |
| CAMBRIDGE ASSOCICATES, LLC EIN 04-3515240 NONE | Investment advisory (plan); Consulting fees Service code 27 | — | $76K |
| EMPLOYEE ID 519 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $76K |
| EMPLOYEE ID 543 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $74K |
| NEXUS TECHNOLOGIES EIN 84-1432041 NONE | Other services Service code 49 | — | $71K |
| EMPLOYEE ID 548 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $70K |
| VISION SERVICE PLAN -(CA) EIN 94-1632821 NONE | Insurance services Service code 23 | — | $69K |
| EMPLOYEE ID 523 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $67K |
| EMPLOYEE ID 446 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $64K |
| EMPLOYEE ID 549 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $64K |
| EMPLOYEE ID 120 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $64K |
| IAPPSYS INC. EIN 20-2774279 NONE | Consulting (general) Service code 16 | — | $63K |
| EMPLOYEE ID 432 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $61K |
| EMPLOYEE ID 583 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $61K |
| VITECH SYSTEMS SUB LLC EIN 13-3785492 NONE | Other services Service code 49 | — | $59K |
| EMPLOYEE ID 580 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $58K |
| STATE STREET BANK AND TRUST COMPANY EIN 04-1867445 NONE | Custodial (securities) Service code 19 | — | $58K |
| EMPLOYEE ID 426 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $57K |
| EMPLOYEE ID 401 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $55K |
| EMPLOYEE ID 431 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $55K |
| EMPLOYEE ID 197 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $55K |
| EMPLOYEE ID 474 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $54K |
| EMPLOYEE ID 346 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $54K |
| EMPLOYEE ID 437 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $50K |
| EMPLOYEE ID 412 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $50K |
| EMPLOYEE ID 447 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $46K |
| EMPLOYEE ID 114 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $45K |
| EMPLOYEE ID 264 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $44K |
| EMPLOYEE ID 207 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $43K |
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 | 7,475 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,665 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 9,140 | 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.