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 |
|---|---|---|---|
| HEALTHSMART BENEFIT SOLUTIONS EIN 36-4099199 NONE | Direct payment from the plan; Claims processing; Contract Administrator Service code 12 | — | $191K |
| KEYSTONE PEER REVIEW ORGANIZATION EIN 23-2348176 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $177K |
| PIMCO EIN 33-0629048 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | — | $130K |
| LOOMIS SAYLES TRUST COMPANY EIN 20-8080381 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | — | $92K |
| POWERS PYLES SUTTER & VERVILLE EIN 52-1620214 NONE | Legal Service code 29 | — | $84K |
| WITHUMSMITH+BROWN EIN 22-2027092 NONE | Accounting (including auditing) Service code 10 | — | $70K |
| INCOME RESEARCH + MANAGEMENT EIN 04-2955404 NONE | Investment management fees paid directly by plan Service code 51 | — | $50K |
| 1974 PENSION TRUST EIN 52-6150908 EMPLOYER | Investment management; Accounting (including auditing); Legal Service code 10 | — | $31K |
| SEGAL MARCO ADVISORS EIN 13-2646110 NONE | Investment management Service code 28 | — | $17K |
| AMALGAMATED BANK EIN 13-4920330 NONE | Investment management fees paid indirectly by plan; Custodial (securities); Investment management fees paid directly by plan; Investment management Service code 19 | — | $15K |
| NORTHERN TRUST COMPANY EIN 36-1561860 NONE | Other fees; Account maintenance fees; Custodial (securities) Service code 19 | — | $14K |
| UNITED ACTUARIAL SERVICE EIN 35-2156428 NONE | Actuarial Service code 11 | — | $13K |
| CCRC ACTUARIES LLC EIN 52-2261050 NONE | Actuarial Service code 11 | — | $9K |
| BLACKROCK INST TRUST CO. FKA BGI EIN 94-3112180 NONE | Investment management; Direct payment from the plan Service code 28 | — | $1K |
| CVS PHARMACY, INC. EIN 05-0340626 NONE | Claims processing; Other fees Service code 12 | — | $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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 496 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 496 | 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.