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 |
|---|---|---|---|
| BERT BELL/PETE ROZELLE NFL PLAYER EIN 13-6043636 NONE | Other services; Direct payment from the plan Service code 49 | — | $5.0M |
| GROOM LAW GROUP EIN 52-1219029 NONE | Legal; Direct payment from the plan Service code 29 | — | $1.4M |
| BERNSTEIN & MCCASLAND, MD, PC EIN 58-1318583 NONE | Other services; Direct payment from the plan Service code 49 | — | $307K |
| ERIC J. BRAHIN, M.D., M.S.E NONE | Other services; Direct payment from the plan Service code 49 | 96 REYNOSA SAN ANTONIO, TX 78261 | $288K |
| JOHNNY HUNG-CHI WEN, PHD EIN 20-8253877 NONE | Other services; Direct payment from the plan Service code 49 | — | $266K |
| ATLANTA NEUROPSYCHOLOGY, LLC EIN 46-1232782 NONE | Other services; Direct payment from the plan Service code 49 | — | $204K |
| RAYMOND FABER NONE | Direct payment from the plan; Other services Service code 49 | 11703 HUEBNER ROAD SUITE 106-273 SAN ANTONIO, TX 78230 | $187K |
| PEACHTREE ORTHOPAEDIC CLINIC EIN 58-1080740 NONE | Direct payment from the plan; Other services Service code 49 | — | $170K |
| EDWARD O'CONNOR EIN 20-0579634 NONE | Other services; Direct payment from the plan Service code 49 | — | $161K |
| DAVID APPLE, M.D. NONE | Direct payment from the plan; Other services Service code 49 | 660 COLLIER COMMONS CIRCLE ATLANTA, GA 30318 | $161K |
| ALL FLORIDA ORTHOPAEDICS ASSOCIATES EIN 59-2681990 NONE | Direct payment from the plan; Other services Service code 49 | — | $157K |
| AON EIN 22-2232264 NONE | Actuarial; Consulting (general); Direct payment from the plan Service code 11 | — | $150K |
| ALLEN JACKSON NONE | Other services; Direct payment from the plan Service code 49 | PO BOX 188 MEDINA, WA 98039 | $143K |
| ROBERT A. BORNSTEIN, PH.D. NONE | Direct payment from the plan; Other services Service code 49 | 370 W. 9TH AVE ROOM 237 COLUMBUS, OH 43210 | $138K |
| OSU NEUROSCIENCE CENTER, LLC EIN 31-1466115 NONE | Other services; Direct payment from the plan Service code 49 | — | $134K |
| FONDREN ORTHOPEDIC GROUP, LLP EIN 76-0363583 NONE | Direct payment from the plan; Other services Service code 49 | — | $133K |
| CHICAGO NEUROPSYCHOLOGY GROUP NONE | Direct payment from the plan; Other services Service code 49 | 333 N. MICHIGAN AVENUE SUITE 1801 CHICAGO, IL 60601 | $130K |
| JANYNA MERCADO, PH.D. NONE | Other services; Direct payment from the plan Service code 49 | 19430 CAMINO RIDGE SAN ANTONIO, TX 78258 | $128K |
| SUTAPA MCNASBY, PH.D. NONE | Other services; Direct payment from the plan Service code 49 | 4703 CARLTON CROSSING DRIVE DURHAM, NC 27713 | $124K |
| HARLAN SELESNICK, M.D. NONE | Other services; Direct payment from the plan Service code 49 | 7501 SW 104TH STREET MIAMI, FL 33156 | $120K |
| JAMES L. CHEN, M.D. EIN 45-5051429 NONE | Direct payment from the plan; Other services Service code 49 | — | $117K |
| RODNEY D. VANDERPLOEG, PH.D. NONE | Direct payment from the plan; Other services Service code 49 | 5322 PRIMROSE LAKE CIRCLE SUITE G TAMPA, FL 33647 | $112K |
| CHICAGO PSYCHIATRY ASSOCIATES EIN 46-5610304 NONE | Direct payment from the plan; Other services Service code 49 | — | $110K |
| JOSEPH D. EUBANKS, PH.D. NONE | Direct payment from the plan; Other services Service code 49 | 5101 MEDICAL DRIVE SAN ANTONIO, TX 78229 | $106K |
| KANSAS CITY SPINE & SPORTS MED EIN 80-0609778 NONE | Direct payment from the plan; Other services Service code 49 | — | $99K |
| PAUL SAENZ, D.O., P.A. EIN 74-2613458 NONE | Direct payment from the plan; Other services Service code 49 | — | $97K |
| PERRY ORTHOPEDICS & SPORTS MEDICINE EIN 56-2258322 NONE | Direct payment from the plan; Other services Service code 49 | — | $92K |
| ORRIN SHERMAN, M.D. NONE | Direct payment from the plan; Other services Service code 49 | 114 EAST 72ND STREET 14C NEW YORK, NY 10021 | $90K |
| CALFIDUCIARY SERVICES, INC. EIN 47-5477044 NONE | Other services; Direct payment from the plan Service code 49 | — | $88K |
| WILLIAM GARMOE, PH.D. NONE | Direct payment from the plan; Other services Service code 49 | 14300 GALLANT FOX LANE SUITE 107 BOWIE, MD 20715 | $88K |
| CENTER FOR ATHELETIC MEDICINE, LTD EIN 36-3815402 NONE | Other services; Direct payment from the plan Service code 49 | — | $87K |
| MARK TULLMAN, M.D. NONE | Direct payment from the plan; Other services Service code 49 | 20 FRONTENAC ESTATES DRIVE FRONTENAC, MO 63131 | $84K |
| FRANCISCO I. PEREZ, PH.D. EIN 74-2178016 NONE | Direct payment from the plan; Other services Service code 49 | — | $74K |
| GREGORY MACK, M.D. EIN 20-4015690 NONE | Other services; Direct payment from the plan Service code 49 | — | $74K |
| STEVEN MEIER, M.D. EIN 26-2053717 NONE | Direct payment from the plan; Other services Service code 49 | — | $74K |
| JONATHAN SCHLEIMER, M.D. NONE | Other services; Direct payment from the plan Service code 49 | 9850 GENESEE AVENUE #750 LA JOLLA, CA 92037 | $73K |
| SAN DIEGO SPORTS MEDICINE & ORTHO EIN 33-0834309 NONE | Other services; Direct payment from the plan Service code 49 | — | $71K |
| VIRGIL MEDLOCK III NONE | Direct payment from the plan; Other services Service code 49 | 4408 LIVINGSTON AVE DALLAS, TX 75205 | $63K |
| DENVER VEIL ORTHOPEDICS, P.C. EIN 84-1548304 NONE | Other services; Direct payment from the plan Service code 49 | — | $61K |
| D.C. DELIS CLINICAL PSYCHOLOGIST EIN 81-0608729 NONE | Direct payment from the plan; Other services Service code 49 | — | $59K |
| ORTHOPAEDIC ASSOCIATION OF CHICAGO EIN 36-2731428 NONE | Other services; Direct payment from the plan Service code 49 | — | $59K |
| FLORIDA SPORTS INJURY EIN 45-2806834 NONE | Direct payment from the plan; Other services Service code 49 | — | $59K |
| ALVIN DETTERLINE NONE | Other services; Direct payment from the plan Service code 49 | 13905 FOXLAND ROAD PHOENIX, MD 21131 | $58K |
| MENORAH MEDICAL GROUP EIN 48-1301826 NONE | Direct payment from the plan; Other services Service code 49 | — | $57K |
| OSU HARDING HOSPITAL EIN 31-1340739 NONE | Other services; Direct payment from the plan Service code 49 | — | $53K |
| GAYTARI DEVI, M.D. NONE | Other services; Direct payment from the plan Service code 49 | 65 E. 76TH STREET NEW YORK, NY 10021 | $49K |
| CAROLINA HEADACHE INSTITUTE EIN 27-0823332 NONE | Direct payment from the plan; Other services Service code 49 | — | $48K |
| HEDLEY ORTHOPEDIC INSTITUTE NONE | Direct payment from the plan; Other services Service code 49 | 2122 E. HIGHLAND AVE SUITE 300 PHOENIX, AZ 85016 | $47K |
| THE BANK OF NEW YORK MELLON EIN 13-5160382 NONE | Direct payment from the plan; Investment management fees paid directly by plan; Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $45K |
| PSYCHIATRIC ASSOCIATES OF ATLANTA EIN 01-0683990 NONE | Other services; Direct payment from the plan Service code 49 | — | $45K |
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 | 2,235 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,796 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 6,714 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 10,745 | 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.