No brokers reported on this filing.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENEFITS ADMINISTRATIVE SERVICES CO EIN 34-1627054 NONE | Direct payment from the plan; Contract Administrator; Participant communication Service code 13 | — | $119K |
| MILLIMAN EIN 91-0675641 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $85K |
| WELLS FARGO BANK EIN 94-1347393 NONE | Investment management; Investment management fees paid directly by plan Service code 28 | — | $51K |
| BDO USA, LLP EIN 13-5381590 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $44K |
| GROOM LAW GROUP EIN 52-0969534 NONE | Legal; Direct payment from the plan Service code 29 | — | $40K |
| CDS ADMINISTRATORS, INC. EIN 25-1352803 NONE | Contract Administrator; Direct payment from the plan Service code 13 | — | $32K |
| JOHN T. GRIGSBY EIN 20-8994792 NONE | Direct payment from the plan; Trustee (individual) Service code 20 | — | $26K |
| THE SEGAL COMPANY EIN 13-1835864 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $20K |
| RICHARD LICHTENSTEIN EIN 20-8994792 NONE | Trustee (individual); Direct payment from the plan Service code 20 | — | $15K |
| VISION SERVICE PLAN EIN 31-0725743 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $14K |
| DELTA DENTAL EIN 31-0685339 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $11K |
| DORIS RERICHA EIN 20-8994792 NONE | Direct payment from the plan; Trustee (individual) Service code 20 | — | $9K |
| CHESTER MUSIEL EIN 20-8994792 NONE | Trustee (individual); Direct payment from the plan Service code 20 | — | $6K |
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 | 257 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 257 | 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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.