| Provider | Services | Address | Compensation |
|---|---|---|---|
| SAMBA BENEFIT PLAN EIN 52-1074154 EMPLOYEES | Employee (plan); Direct payment from the plan Service code 30 | — | $1.8M |
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator; Direct payment from the plan Service code 13 | — | $492K |
| COUNTERPOINT SOFTWARE INC. EIN 51-0300805 NONE | Direct payment from the plan; Consulting (general); Other services Service code 16 | — | $474K |
| PNC INSTITUTIONAL INVESTMENTS EIN 25-1211909 NONE | Custodial (securities); Direct payment from the plan Service code 19 | — | $385K |
| CHANGE HEALTHCARE EIN 20-5731067 NONE | Direct payment from the plan; Other services Service code 49 | — | $339K |
| OPTUMINSIGHT, INC. EIN 41-1858498 NONE | Other services Service code 49 | — | $232K |
| BALMAR INC (HBP) EIN 04-3725251 NONE | Other services; Direct payment from the plan; Copying and duplicating Service code 36 | — | $110K |
| EYEMED VISION CARE EIN 80-0773195 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $86K |
| CIGNA EIN 59-1031071 NONE | Named fiduciary; Contract Administrator; Direct payment from the plan; Claims processing; Non-monetary compensation; Other services; Float revenue; Participant communication Service code 12 | — | $70K |
| WITHUMSMITH+BROWN, PC EIN 22-2027092 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $62K |
| WILLIAM P. O'HANLON PRESIDENT, SAMBA BOD | Other services; Consulting (general); Direct payment from the plan Service code 16 | 2496 DURHAM PLACE JEFFERSONTON, VA 22724 | $46K |
| ERMER & SUTER, PLLC EIN 26-1616418 DAVID ERMER-SECRETARY BOD | Legal; Direct payment from the plan Service code 29 | — | $19K |
| MITCHELL I. SEROTA & ASSOCIATES INC EIN 36-3266002 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $8K |
| HOUSE OF PRINTING INC EIN 52-0942907 NONE | Other services; Direct payment from the plan; Copying and duplicating Service code 36 | — | $8K |
| AON CONSULTING INC. EIN 22-2232264 NONE | Accounting (including auditing); Actuarial; Consulting (general); Direct payment from the plan Service code 10 | — | $7K |
| VW BROWN INSURANCE SERVICE LLC EIN 26-0274369 NONE | Insurance agents and brokers; Investment management fees paid indirectly by plan Service code 22 | — | $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 | 101,059 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 101,059 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AETNA LIFE INSURANCE CO. | 5,894 | $2.2M |
| Life insurance(2 contracts) | RELIASTAR LIFE INSURANCE COMPANY | 87,612 | $11.2M |
| Other(2 contracts, 2 carriers) | RELIASTAR LIFE INSURANCE COMPANY | 11,036 | $6.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 87,612 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.