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 |
|---|---|---|---|
| UBS FINANCIAL SERVICES, INC. EIN 13-2638166 INVESTMENT ADVISOR | Investment advisory (plan) Service code 27 | — | $56K |
| FIRLEY, MORAN, FREER & EASSA, CPA EIN 16-1148763 ACCOUNTANT | Accounting (including auditing) Service code 10 | — | $13K |
| MASSACHUSETTS MUTUAL LIFE INS. CO. EIN 04-1590850 CONTRACT ADMINISTRATOR | Float revenue; Other investment fees and expenses; Sub-transfer agency fees; Distribution (12b-1) fees; Recordkeeping fees; Investment management fees paid indirectly by plan; Other services; Soft dollars commissions Service code 49 | — | $1K |
| AMERICAN FUNDS EIN 95-1411037 INVESTMENT PROVIDER | Investment management fees paid indirectly by plan Service code 52 | — | $0 |
| FIDELITY INVESTMENTS EIN 04-6056833 INVESTMENT PROVIDER | Investment management fees paid indirectly by plan Service code 52 | — | $0 |
| LEGG MASON EIN 95-2705767 INVESTMENT PROVIDER | Investment management fees paid indirectly by plan Service code 52 | — | $0 |
| MFS INVESTMENT MANAGEMENT EIN 04-3158862 INVESTMENT PROVIDER | Investment management fees paid indirectly by plan Service code 52 | — | $0 |
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 | 109 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 24 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 1 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 135 | 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.