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 I 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 | — | $712K |
| DELTA DENTAL OF CALIFORNIA EIN 94-1461312 NONE | Claims processing; Plan Administrator; Direct payment from the plan Service code 12 | — | $417K |
| THE SEGAL COMPANY (WESTERN STATES), EIN 94-1503999 NONE | Consulting (general); Actuarial Service code 11 | — | $398K |
| MEDICAL REVIEW INSTITUTE OF AMERICA EIN 87-0515201 NONE | Consulting fees Service code 70 | — | $303K |
| NIGRO KARLIN SEGAL FELDSTEIN & BOLN EIN 95-3632775 NONE | Accounting (including auditing) Service code 10 | — | $226K |
| BLACKROCK INVESTMENT MANAGEMENT, LL EIN 20-5319476 NONE | Investment management; Direct payment from the plan; Investment management fees paid directly by plan Service code 28 | — | $224K |
| EXPRESS SCRIPTS, INC. EIN 22-3461740 NONE | Claims processing Service code 12 | — | $205K |
| CVS PHARMACY, INC. EIN 05-0340626 NONE | Claims processing Service code 12 | — | $192K |
| EMPLOYEE ID 115 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $176K |
| EMPLOYEE ID 520 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $143K |
| SEGAL SELECT INSURANCE SERVICES INC EIN 46-0619194 NONE | Insurance brokerage commissions and fees Service code 53 | — | $142K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $99K |
| EMPLOYEE ID 278 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $96K |
| EMPLOYEE ID 121 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $93K |
| EMPLOYEE ID 538 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $92K |
| CAMBRIDGE ASSOCIATES, LLC EIN 04-3515240 NONE | Consulting fees; Investment advisory (plan) Service code 27 | — | $90K |
| EMPLOYEE ID 519 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $89K |
| EMPLOYEE ID 195 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $89K |
| EMPLOYEE ID 543 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $87K |
| EMPLOYEE ID 446 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $82K |
| VISION SERVICE PLAN-(CA) EIN 94-1632821 NONE | Insurance services Service code 23 | — | $82K |
| EMPLOYEE ID 523 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $81K |
| CENTERSQUARE INVESTMENT MANAGEMENT, EIN 82-2740355 NONE | Investment management; Soft dollars commissions Service code 28 | — | $81K |
| EMPLOYEE ID 200 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $80K |
| EMPLOYEE ID 513 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $79K |
| STEVEN M. SIMONS, M.D., INC. EIN 95-3524994 NONE | Consulting (general) Service code 16 | — | $79K |
| EMPLOYEE ID 548 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $73K |
| EMPLOYEE ID 583 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $70K |
| EMPLOYEE ID 549 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $69K |
| EMPLOYEE ID 594 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $68K |
| EMPLOYEE ID 120 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $67K |
| EMPLOYEE ID 346 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $64K |
| EMPLOYEE ID 426 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $61K |
| EMPLOYEE ID 580 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $59K |
| EMPLOYEE ID 401 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $59K |
| STATE STREET BANK & TRUST EIN 04-1867445 NONE | Custodial (securities) Service code 19 | — | $58K |
| EMPLOYEE ID 431 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $57K |
| EMPLOYEE ID 437 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $53K |
| EMPLOYEE ID 474 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $53K |
| EMPLOYEE ID 601 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $51K |
| EMPLOYEE ID 264 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $51K |
| VITECH SYSTEMS SUB LLC EIN 13-3785492 NONE | Other services Service code 49 | — | $50K |
| EMPLOYEE ID 569 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $48K |
| EMPLOYEE ID 114 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $48K |
| EMPLOYEE ID 447 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $47K |
| EMPLOYEE ID 399 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $47K |
| EMPLOYEE ID 207 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $44K |
| EMPLOYEE ID 596 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $44K |
| EMPLOYEE ID 507 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $42K |
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 | 7,444 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,469 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 8,913 | 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.