| Provider | Services | Address | Compensation |
|---|---|---|---|
| SAMBA BENEFIT PLAN EIN 52-1074154 EMPLOYEE | Employee (plan); Direct payment from the plan Service code 30 | — | $1.8M |
| RAM TECHNOLOGIES NONE | Other services; Direct payment from the plan Service code 49 | 275 COMMERCE DRIVE SUITE 100 FORT WASHINGTON, PA 19034 | $567K |
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator; Direct payment from the plan Service code 13 | — | $555K |
| OPTUM, INC EIN 30-0580620 NONE | Direct payment from the plan; Other services Service code 49 | — | $383K |
| COUNTERPOINT SOFTWARE INC EIN 51-0300805 NONE | Other services; Direct payment from the plan; Consulting (general) Service code 16 | — | $365K |
| PNC INSTITUTIONAL INVESTMENTS EIN 25-1211909 NONE | Custodial (securities); Direct payment from the plan Service code 19 | — | $291K |
| BALMAR INC (HBP) EIN 04-3725251 NONE | Other services; Copying and duplicating; Direct payment from the plan Service code 36 | — | $145K |
| OPTUMINSIGHT, INC EIN 41-1858498 NONE | Direct payment from the plan; Other services Service code 49 | — | $128K |
| CAROUSEL INDUSTRIES OF NORTH AMERIC NONE | Direct payment from the plan; Other services Service code 49 | 659 SOUTH COUNTY TRAIL EXETER, RI 02822 | $86K |
| EYEMED VISON CARE EIN 80-0773195 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $85K |
| WITHUMSMITH+BROWN PC EIN 22-2027092 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $78K |
| MARY LIVINGSTON NONE | Direct payment from the plan; Consulting (general) Service code 16 | 1406 KNIGHTSBRIDGE TURN CROFTON, MD 21114 | $73K |
| CIGNA EIN 59-1031071 NONE | Participant communication; Direct payment from the plan; Non-monetary compensation; Claims processing; Contract Administrator; Other services; Float revenue; Named fiduciary Service code 12 | — | $48K |
| WILLIAM P O'HANLON PRESIDENT, SAMBA BOD | Trustee (individual); Accounting (including auditing); Direct payment from the plan; Consulting (general) Service code 10 | 2496 DURHAM PLACE JEFFERSONTON, VA 22724 | $46K |
| CRAYON SOFTWARE EXPERTS LLC EIN 47-2237420 NONE | Direct payment from the plan; Other services Service code 49 | — | $27K |
| DATABANK HOLDINGS LTD EIN 83-0409949 NONE | Other services; Direct payment from the plan Service code 49 | — | $26K |
| HOUSE OF PRINTING INC EIN 52-0942907 NONE | Copying and duplicating; Direct payment from the plan; Other services Service code 36 | — | $22K |
| TYCO FIRE AND SECURITY MANAGEMENT EIN 80-0706067 NONE | Direct payment from the plan; Other services Service code 49 | — | $15K |
| NTIRETY, INC EIN 26-4826233 NONE | Direct payment from the plan; Other services Service code 49 | — | $14K |
| THE WAGNER LAW GROUP EIN 04-3323315 NONE | Legal; Direct payment from the plan Service code 29 | — | $12K |
| LYNN CHANG NONE | Direct payment from the plan; Consulting (general) Service code 16 | 114 BECKWITH STREET GAITHERSBURG, MD 20878 | $10K |
| ERMER & SUTER, PLLC EIN 26-1616418 DAVID ERMER-SECRETARY BOD | Legal; Direct payment from the plan Service code 29 | — | $10K |
| MITCHELL I. SEROTA & ASSOCIATES INC EIN 36-3266002 NONE | Direct payment from the plan; Actuarial Service code 11 | — | $9K |
| VW BROWN INSURANCE SERVICE LLC EIN 26-0274369 NONE | Insurance agents and brokers; Insurance brokerage commissions and fees 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 | 91,626 | 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) | 91,626 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AETNA LIFE INSURANCE CO. | 5,472 | $2.0M |
| Life insurance(2 contracts) | RELIASTAR LIFE INSURANCE COMPANY | 77,691 | $11.9M |
| Other(2 contracts, 2 carriers) | RELIASTAR LIFE INSURANCE COMPANY | 9,452 | $6.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 77,691 | — |
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.