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 | Float revenue; Contract Administrator; Claims processing; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $2.6M |
| CVS PHARMACY, INC. EIN 05-0340626 NONE | Claims processing Service code 12 | — | $753K |
| DELTA DENTAL OF CALIFORNIA EIN 94-1461312 NONE | Direct payment from the plan; Plan Administrator; Claims processing Service code 12 | — | $464K |
| SEYFARTH SHAW LLP EIN 36-2152202 NONE | Legal Service code 29 | — | $462K |
| THE SEGAL COMPANY (WESTERN STATES) EIN 94-1503999 NONE | Consulting (general); Actuarial Service code 11 | — | $459K |
| MEDICAL REVIEW INSTITUTE OF AMERICA EIN 87-0515201 NONE | Consulting fees Service code 70 | — | $447K |
| SEGAL SELECT INSURANCE SERVICES INC EIN 46-0619194 NONE | Insurance brokerage commissions and fees Service code 53 | — | $235K |
| NIGRO KARLIN SEGAL & FELDSTEIN, LLP EIN 95-3632775 NONE | Accounting (including auditing) Service code 10 | — | $217K |
| VITECH SYSTEMS SUB LLC EIN 13-3785492 NONE | Other services Service code 49 | — | $208K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $171K |
| EMPLOYEE ID 538 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $130K |
| STEVEN M. SIMONS, M.D., INC. EIN 95-3524994 NONE | Consulting (general) Service code 16 | — | $111K |
| EMPLOYEE ID 121 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $105K |
| EMPLOYEE ID 278 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $93K |
| EMPLOYEE ID 543 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $87K |
| EMPLOYEE ID 548 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $87K |
| EMPLOYEE ID 513 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $86K |
| VISION SERVICE PLAN-(CA) EIN 94-1632821 NONE | Claims processing; Insurance services Service code 12 | — | $86K |
| CAMBRIDGE ASSOCIATES, LLC EIN 04-3515240 NONE | Investment advisory (plan); Consulting fees Service code 27 | — | $86K |
| IAPPSYS, INC. EIN 20-2774279 NONE | Consulting (general) Service code 16 | — | $85K |
| EMPLOYEE ID 120 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $71K |
| EMPLOYEE ID 195 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $70K |
| EMPLOYEE ID 609 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $68K |
| EMPLOYEE ID 437 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $65K |
| EMPLOYEE ID 401 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $65K |
| EMPLOYEE ID 583 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $64K |
| EMPLOYEE ID 523 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $63K |
| EMPLOYEE ID 115 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $62K |
| EMPLOYEE ID 346 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $60K |
| BUSH GOTTLIEB, A LAW CORPORATION EIN 95-2956616 NONE | Legal Service code 29 | — | $58K |
| EMPLOYEE ID 114 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $57K |
| EMPLOYEE ID 618 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $56K |
| EMPLOYEE ID 549 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $56K |
| EMPLOYEE ID 629 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $56K |
| EMPLOYEE ID 621 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $51K |
| EMPLOYEE ID 447 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $50K |
| EMPLOYEE ID 639 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $50K |
| EMPLOYEE ID 399 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $49K |
| EMPLOYEE ID 626 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $49K |
| EMPLOYEE ID 434 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $49K |
| EMPLOYEE ID 474 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $48K |
| EMPLOYEE ID 598 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $47K |
| EMPLOYEE ID 207 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $46K |
| EMPLOYEE ID 637 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $46K |
| AGIO INC EIN 84-4093832 NONE | Other services Service code 49 | — | $46K |
| EMPLOYEE ID 633 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $46K |
| EMPLOYEE ID 585 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $44K |
| EMPLOYEE ID 653 EIN 51-0137697 NONE | Employee (plan) Service code 30 | — | $43K |
| WELLINGTON TRUST COMPANY NA EIN 04-2755549 NONE | Investment management fees paid directly by plan Service code 51 | — | $43K |
| EMPLOYEE ID 264 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 | 8,069 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,515 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 9,584 | 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.