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 |
|---|---|---|---|
| BLACK, DONALD EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $143K |
| DATA DESIGN SYSTEMS EIN 27-3172883 | Other fees Service code 99 | — | $140K |
| GUTIERREZ, JR., MANUEL EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $120K |
| SINGLETON, JAMES D. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $114K |
| GROVES, RICHARD E. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $113K |
| SEMAN, ROBERT EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $113K |
| FLETCHER, MARK EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $108K |
| CAMECHIS, JAMES B. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $99K |
| WILSON, KERRICK EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $96K |
| DRAKE, BRANDON L. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $96K |
| BRAUNSTEIN, WILLIAM J. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $95K |
| RUNK, MARK A. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $95K |
| PAUL, MICHAEL C. EIN 31-4446857 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $95K |
| IRWIN, JASON W. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $95K |
| OBERLIN, JOHN EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $95K |
| RIGGI, JEFFREY S. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $95K |
| VAN FOSSEN, MICHAEL W. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $95K |
| BROOKS, BENJAMIN P. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $94K |
| BUTCHER, BRENT C. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $94K |
| CRAIG, JASON M. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $94K |
| DEARTH, TRENT R. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $94K |
| DECK, JASON M. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $94K |
| EWERSEN, ERIC EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $94K |
| FUENTES, MATTHEW T. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $94K |
| HALL, DECARLOS R. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $94K |
| HENDERSON, MICHAEL R. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $94K |
| IRWIN, EVAN A. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $94K |
| MATOUSEK, ERIC J. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $94K |
| SUGGS, CHRISTOPHER D. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $94K |
| WORLEY, JOSEPH W. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $94K |
| SNURE, CHARLES W. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $87K |
| YATES, MELVIN E. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $86K |
| STOCK, JOHN F. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $85K |
| GRISIPINO, JOSEPH V. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $83K |
| MILLER, CURTIS J. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $83K |
| GOINS, CARL G. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $71K |
| STEKLE, ALISHA EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $65K |
| SPENCER, MARK E. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $65K |
| TUCKER, TERRI L. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $65K |
| RADWANSKI, TIMOTHY A. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $65K |
| EROSHEVICH, SASHA EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $64K |
| BAILEY, CHRISTY EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $64K |
| BLACK, SHELBY N. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $63K |
| MCDONALD, SHERRI L. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $63K |
| COOPER, DERRICK M. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $62K |
| NORRIS, MARK A. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $45K |
| CINTAS EIN 31-1188630 | Other fees Service code 99 | — | $41K |
| WHITE FACILITY SERVICES, INC. EIN 11-3842140 | Other fees Service code 99 | — | $41K |
| FASTZKIE, NICOLE L. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $40K |
| RONSKI, DAWN F. EIN 31-6057717 EMPLOYEE | Employee (plan sponsor) Service code 35 | — | $25K |
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 | 10,044 | Currently employed and enrolled or eligible. |
| Retired/separated still eligible | 18,566 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 28,610 | 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."
No prospect flags tripped on this filing.