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 INS EIN 95-4331852 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Float revenue; Claims processing Service code 12 | — | $2.2M |
| CVS PHARMACY, INC. EIN 05-0340626 NONE | Claims processing Service code 12 | — | $1.0M |
| SEYFARTH SHAW LLP EIN 36-2152202 NONE | Legal Service code 29 | — | $685K |
| DELTA DENTAL OF CALIFORNIA EIN 94-1461312 NONE | Direct payment from the plan; Plan Administrator; Claims processing Service code 12 | — | $414K |
| THE SEGAL COMPANY (WESTERN STATES) EIN 94-1503999 NONE | Consulting (general); Actuarial Service code 11 | — | $412K |
| MEDICAL REVIEW INSTITUTE OF AMERICA EIN 87-0515201 NONE | Consulting fees Service code 70 | — | $350K |
| EMPLOYEE ID 115 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $232K |
| NIGRO KARLIN SEGAL FELDSTEIN & BOLN EIN 95-3632775 NONE | Accounting (including auditing) Service code 10 | — | $217K |
| SEGAL SELECT INSURANCE SERVICES INC EIN 46-0619194 NONE | Insurance brokerage commissions and fees Service code 53 | — | $197K |
| VITECH SYSTEMS SUB LLC EIN 13-3785492 NONE | Other services Service code 49 | — | $181K |
| EMPLOYEE ID 520 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $139K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $122K |
| EMPLOYEE ID 538 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $101K |
| WESTERN ASSET MANAGEMENT COMPANY EIN 52-1200960 NONE | Investment management Service code 28 | — | $99K |
| EMPLOYEE ID 121 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $99K |
| EMPLOYEE ID 278 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $95K |
| EMPLOYEE ID 200 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $86K |
| EMPLOYEE ID 513 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $85K |
| IAPPSYS INC. EIN 20-2774279 NONE | Consulting (general) Service code 16 | — | $84K |
| VISION SERVICE PLAN-(CA) EIN 94-1632821 NONE | Claims processing Service code 12 | — | $81K |
| STEVEN M. SIMONS, M.D., INC. EIN 95-3524994 NONE | Consulting (general) Service code 16 | — | $80K |
| EMPLOYEE ID 548 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $76K |
| CAMBRIDGE ASSOCIATES, LLC EIN 04-3515240 NONE | Investment advisory (plan); Consulting fees Service code 27 | — | $76K |
| EMPLOYEE ID 543 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $75K |
| EMPLOYEE ID 195 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $72K |
| EMPLOYEE ID 120 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $68K |
| EMPLOYEE ID 446 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $65K |
| EMPLOYEE ID 523 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $64K |
| EMPLOYEE ID 401 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $61K |
| EMPLOYEE ID 583 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $60K |
| EMPLOYEE ID 609 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $59K |
| EMPLOYEE ID 431 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $55K |
| EMPLOYEE ID 549 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $53K |
| EMPLOYEE ID 346 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $52K |
| EMPLOYEE ID 507 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $51K |
| EMPLOYEE ID 618 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $51K |
| EMPLOYEE ID 114 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $51K |
| EMPLOYEE ID 474 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $51K |
| EMPLOYEE ID 621 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $50K |
| EMPLOYEE ID 447 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $48K |
| EMPLOYEE ID 437 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $48K |
| EMPLOYEE ID 399 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $48K |
| EMPLOYEE ID 207 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 434 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $42K |
| BUSH GOTTLIEB, A LAW CORPORATION EIN 95-2956616 NONE | Legal Service code 29 | — | $40K |
| EMPLOYEE ID 469 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $40K |
| EMPLOYEE ID 246 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $39K |
| EMPLOYEE ID 585 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $38K |
| EMPLOYEE ID 210 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $36K |
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 | 8,244 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,419 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 9,663 | 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.