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 | — | $5.8M |
| GROOM LAW GROUP EIN 52-1219029 NONE | Legal; Direct payment from the plan Service code 29 | — | $2.7M |
| JANYNA MERCADO, PHD NONE | Direct payment from the plan; Other services Service code 49 | 19430 CAMINO RIDGE SAN ANTONIO, TX 78258 | $293K |
| ERIC J. BRAHIN, MD, PLLC EIN 46-4435141 NONE | Other services; Direct payment from the plan Service code 49 | — | $240K |
| ALLEN JACKSON, MD NONE | Direct payment from the plan; Other services Service code 49 | PO BOX 188 MEDINA, WA 98039 | $230K |
| JOHNNY HUNG-CHI WEN, PHD EIN 20-8253877 NONE | Direct payment from the plan; Other services Service code 49 | — | $230K |
| PEACHTREE ORTHOPAEDIC CLINIC EIN 58-1080740 NONE | Other services; Direct payment from the plan Service code 49 | — | $203K |
| SUTAPA MCNASBY, PHD NONE | Other services; Direct payment from the plan Service code 49 | 4703 CARLTON CROSSING DRIVE DURHAM, NC 27713 | $197K |
| DAVID APPLE, MD NONE | Other services; Direct payment from the plan Service code 49 | 660 COLLIER COMMONS CIRCLE ATLANTA, GA 30318 | $195K |
| RAYMOND FABER, MD NONE | Direct payment from the plan; Other services Service code 49 | 11703 HUEBNER ROAD SUITE 106-273 SAN ANTONIO, TX 78230 | $181K |
| ATLANTA NEUROPSYCHOLOGY, LLC EIN 46-1232782 NONE | Direct payment from the plan; Other services Service code 49 | — | $178K |
| ALL FLORIDA ORTHOPAEDICS ASSOCIATES EIN 59-2681990 NONE | Direct payment from the plan; Other services Service code 49 | — | $176K |
| EDWARD O'CONNOR, MD EIN 20-0579634 NONE | Other services; Direct payment from the plan Service code 49 | — | $176K |
| BARRY MCCASLAND, MD, PC EIN 58-1318583 NONE | Other services; Direct payment from the plan Service code 49 | — | $172K |
| RODNEY D. VANDERPLOEG, PHD NONE | Other services; Direct payment from the plan Service code 49 | 5322 PRIMROSE LAKE CIRCLE SUITE G TAMPA, FL 33647 | $152K |
| JAMES L. CHEN, MD EIN 45-5051429 NONE | Other services; Direct payment from the plan Service code 49 | — | $150K |
| WILLIAM GARMOE, PHD NONE | Direct payment from the plan; Other services Service code 49 | 14300 GALLANT FOX LANE SUITE 107 BOWIE, MD 20715 | $145K |
| STEVEN MEIER, MD EIN 26-2053717 NONE | Direct payment from the plan; Other services Service code 49 | — | $141K |
| PSYCHIATRIC ASSOCIATES OF ATLANTA EIN 01-0683990 NONE | Other services; Direct payment from the plan Service code 49 | — | $139K |
| CAROLINA HEADACHE INSTITUTE EIN 27-0823332 NONE | Other services; Direct payment from the plan Service code 49 | — | $137K |
| ROBERT A. BORNSTEIN, PHD NONE | Direct payment from the plan; Other services Service code 49 | 493 BLANDINGS COURT WORTHINGTON, OH 43085 | $135K |
| SILVANA RIGGIO, MD NONE | Other services; Direct payment from the plan Service code 49 | 170 EAST 87TH STREET SUITE W2OC NEW YORK, NY 10128 | $132K |
| AON EIN 22-2232264 NONE | Direct payment from the plan; Actuarial; Consulting (general) Service code 11 | — | $129K |
| VIRGIL MEDLOCK III, MD NONE | Other services; Direct payment from the plan Service code 49 | 4408 LIVINGSTON AVE DALLAS, TX 75205 | $129K |
| CENTER FOR ATHELETIC MEDICINE, LTD EIN 36-3815402 NONE | Other services; Direct payment from the plan Service code 49 | — | $128K |
| PAUL SAENZ, DO, PA EIN 74-2613458 NONE | Other services; Direct payment from the plan Service code 49 | — | $128K |
| FONDREN ORTHOPEDIC GROUP, LLP EIN 76-0363583 NONE | Direct payment from the plan; Other services Service code 49 | — | $125K |
| D.C. DELIS CLINICAL PSYCHOLOGIST EIN 81-0608729 NONE | Direct payment from the plan; Other services Service code 49 | — | $124K |
| HARLAN SELESNICK, MD NONE | Direct payment from the plan; Other services Service code 49 | 7501 SW 104TH STREET MIAMI, FL 33156 | $123K |
| KEVIN KESSLER, MD EIN 20-1388210 NONE | Other services; Direct payment from the plan Service code 49 | — | $122K |
| TAMPA NEUROLOGY ASSOCIATES EIN 59-2919747 NONE | Direct payment from the plan; Other services Service code 49 | — | $120K |
| MENORAH MEDICAL GROUP EIN 48-1301826 NONE | Direct payment from the plan; Other services Service code 49 | — | $111K |
| JONATHAN SCHLEIMER, MD NONE | Direct payment from the plan; Other services Service code 49 | 9850 GENESEE AVENUE #750 LA JOLLA, CA 92037 | $93K |
| CALFIDUCIARY SERVICES, INC. EIN 47-5477044 NONE | Direct payment from the plan; Other services Service code 49 | — | $87K |
| CHICAGO NEUROPSYCHOLOGY GROUP NONE | Direct payment from the plan; Other services Service code 49 | 333 N. MICHIGAN AVENUE SUITE 1801 CHICAGO, IL 60601 | $86K |
| ALVIN DETTERLINE, MD NONE | Other services; Direct payment from the plan Service code 49 | 13905 FOXLAND ROAD PHOENIX, MD 21131 | $85K |
| SAN DIEGO SPORTS MEDICINE & ORTHO EIN 33-0834309 NONE | Direct payment from the plan; Other services Service code 49 | — | $84K |
| CHICAGO PSYCHIATRY ASSOCIATES EIN 46-5610304 NONE | Other services; Direct payment from the plan Service code 49 | — | $79K |
| PERRY ORTHO & SPORTS MEDICINE, PA EIN 56-2258322 NONE | Other services; Direct payment from the plan Service code 49 | — | $73K |
| ORRIN SHERMAN, MD NONE | Other services; Direct payment from the plan Service code 49 | 114 EAST 72ND STREET 14C NEW YORK, NY 10021 | $73K |
| MARK TULLMAN, MD NONE | Direct payment from the plan; Other services Service code 49 | 20 FRONTENAC ESTATES DRIVE FRONTENAC, MO 63131 | $71K |
| FLORIDA SPORTS INJURY EIN 45-2806834 NONE | Direct payment from the plan; Other services Service code 49 | — | $71K |
| KATHERINE BROWNLOWE, MD NONE | Other services; Direct payment from the plan Service code 49 | 2929 NORTH STAR ROAD UPPER ARLINGTON, OH 43221 | $67K |
| BRENDAN KELLEY, MD NONE | Other services; Direct payment from the plan Service code 49 | 136 SAND POINT COURT COPPELL, TX 75019 | $66K |
| JOHN HEFFERON, MD NONE | Direct payment from the plan; Other services Service code 49 | 1355 N. SANDBURG TERRACE APT 508 CHICAGO, IL 60610 | $66K |
| GREGORY MACK, MD EIN 20-4015690 NONE | Direct payment from the plan; Other services Service code 49 | — | $61K |
| RR DONNELLEY RECEIVABLES, INC EIN 52-2125127 NONE | Copying and duplicating; Direct payment from the plan Service code 36 | — | $59K |
| DENVER VEIL ORTHOPEDICS, PC EIN 84-1548304 NONE | Direct payment from the plan; Other services Service code 49 | — | $58K |
| JOSEPH CHAD HOYLE, MD NONE | Other services; Direct payment from the plan Service code 49 | 4166 BRYSON COVE CIRCLE DUBLIN, OH 43210 | $57K |
| THE BANK OF NEW YORK MELLON EIN 13-5160382 NONE | Investment management fees paid directly by plan; Direct payment from the plan; Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $55K |
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 | 2,264 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,850 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 6,411 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 10,525 | 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.