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 |
|---|---|---|---|
| BENESYS, INC. EIN 38-2383171 THIRD PARTY ADMINISTRATO | Claims processing; Contract Administrator Service code 12 | 700 TOWER DRIVE TROY, MI 48098 | $319K |
| ANTHEM BLUE CROSS & BLUE SHIELD ADMIN FEES | Claims processing Service code 12 | PO BOX 951254 CLEVELAND, OH 44193 | $202K |
| THE SEGAL COMPANY EIN 13-1975125 ACTUARIAL | Actuarial Service code 11 | 1300 E. 9TH ST, STE 1900 CLEVELAND, OH 44114 | $70K |
| ENVISION PHARMACEUTICAL EIN 05-0570786 CLAIMS PROCESSING | Claims processing Service code 12 | — | $31K |
| ALLOTTA, FARLEY CO., LPA EIN 34-1316963 LEGAL SERVICES | Legal Service code 29 | 2222 CENTENNIAL ROAD TOLEDO, OH 43617 | $19K |
| WELLINGTON TRUST EIN 04-6657591 INVESTMENT ADVISOR | Investment advisory (plan) Service code 27 | 75 STATE STREET BOSTON, MA 02109 | $18K |
| BEHAVIOR MANAGEMENT EIN 34-1577568 CLAIMS PROCESSING | Claims processing Service code 12 | — | $17K |
| SMW LOCAL 33 FRINGE BENEFIT FUND EIN 34-1398805 ADMIN FEES | Plan Administrator Service code 14 | — | $17K |
| SUMMIT STRATEGIES INVESTMENT ADVISOR | Investment advisory (plan) Service code 27 | 8182 MARYLAND AVE, 6TH FL ST. LOUIS, MO 63105 | $13K |
| TRAMER, SHORE & ZWICK EIN 34-1736265 AUDITOR | Accounting (including auditing) Service code 10 | 23775 COMMERCE PARK BEACHWOOD, OH 44122 | $10K |
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 | 530 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 179 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 709 | 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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.