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 |
|---|---|---|---|
| JAMES CLARK NONE | Plan Administrator; Direct payment from the plan Service code 14 | 3500 PENTAGON BLVD BEAVERCREEK, OH 45432 | $211K |
| KATELIN A. MANTIA NONE | Employee (plan); Direct payment from the plan Service code 30 | 3500 PENTAGON BLVD BEAVERCREEK, OH 45431 | $122K |
| WILLIE THORPE NONE | Plan Administrator; Direct payment from the plan Service code 14 | 3500 PENTAGON BLVD BEAVERCREEK, OH 45432 | $113K |
| SEGAL MARCO ADVISORS NONE | Investment advisory (plan); Investment management; Direct payment from the plan Service code 27 | 550 W. WASHINGTON BLVD. CHICAGO, IL 60661 | $90K |
| LAZARD ASSET MANAGEMENT NONE | Direct payment from the plan; Investment advisory (plan) Service code 27 | P.O. BOX 5394 NEW YORK, NY 101855394 | $83K |
| RED HAWK TECHNOLOGIES LLC NONE | Other services; Direct payment from the plan Service code 49 | P.O. BOX 72551 NEWPORT, KY 41072 | $44K |
| HAMMERMAN, GRAF, HUGHES & CO., INC. EIN 31-1183837 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | 7677 PARAGON RD SUITE A DAYTON, OH 45459 | $19K |
| LESLIE CASH TRUSTEE | Trustee (individual); Direct payment from the plan Service code 20 | 3500 PENTAGON BLVD BEAVERCREEK, OH 45432 | $18K |
| MARCUS STEVE LYKINS TRUSTEE | Trustee (individual); Direct payment from the plan Service code 20 | 3500 PENTAGON BLVD BEAVERCREEK, OH 45432 | $18K |
| MARLANE BENGRY TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | 3500 PENTAGON BLVD BEAVERCREEK, OH 45432 | $18K |
| NAN WHALEY TRUSTEE | Trustee (individual); Direct payment from the plan Service code 20 | 3500 PENTAGON BLVD BEAVERCREEK, OH 45432 | $18K |
| PETER MITCHELL TRUSTEE | Direct payment from the plan; Trustee (individual) Service code 20 | 3500 PENTAGON BLVD BEAVERCREEK, OH 45432 | $18K |
| AMALGAMATED BANK NONE | Direct payment from the plan; Custodial (securities); Custodial (other than securities) Service code 18 | — | $17K |
| GREENTREE GROUP NONE | Other services; Direct payment from the plan Service code 49 | 1360 TECHNOLOGY COURT BEAVERCREEK, OH 45430 | $9K |
| COHEN, WEISS, AND SIMON LLP NONE | Legal; Direct payment from the plan Service code 29 | 900 THIRD AVENUE NEW YORK, NY 100224869 | $7K |
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 | 10,513 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 10,513 | 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.