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 |
|---|---|---|---|
| B BELL/P ROZELLE NFL PLAYER RET PL EIN 13-6043636 NONE | Direct payment from the plan; Other services Service code 49 | — | $5.9M |
| GROOM LAW GROUP EIN 52-1219029 NONE | Legal; Direct payment from the plan Service code 29 | — | $2.5M |
| JAMES L. CHEN, M.D., INC. EIN 45-5051429 NONE | Other services; Direct payment from the plan Service code 49 | — | $321K |
| JANYNA MERCADO, PH.D. NONE | Other services; Direct payment from the plan Service code 49 | 19430 CAMINO RIDGE SAN ANTONIO, TX 78258 | $264K |
| KEVIN KESSLER, M.D., P.A. EIN 20-1388210 NONE | Other services; Direct payment from the plan Service code 49 | — | $232K |
| ALLEN JACKSON, M.D. NONE | Other services; Direct payment from the plan Service code 49 | PO BOX 188 MEDINA, WA 98039 | $223K |
| ATLANTA NEUROPSYCHOLOGY, LLC EIN 46-1232782 NONE | Other services; Direct payment from the plan Service code 49 | — | $222K |
| DEAN C. DELIS, CLINICAL PSYCH., INC EIN 81-0608729 NONE | Other services; Direct payment from the plan Service code 49 | — | $218K |
| PSYCHIATRIC ASSOC. OF ATLANTA, LLC EIN 01-0683990 NONE | Direct payment from the plan; Other services Service code 49 | — | $206K |
| ERIC J. BRAHIN, M.D., PLLC EIN 46-4435141 NONE | Direct payment from the plan; Other services Service code 49 | — | $204K |
| BARRY J. MCCASLAND, M.D., P.C. EIN 58-1318583 NONE | Other services; Direct payment from the plan Service code 49 | — | $196K |
| F. HARLAN SELESNICK, M.D. NONE | Direct payment from the plan; Other services Service code 49 | 7501 SW 104TH STREET MIAMI, FL 33156 | $192K |
| 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 | $185K |
| TAMPA NEUROLOGY ASSOCIATES EIN 59-2919747 NONE | Other services; Direct payment from the plan Service code 49 | — | $185K |
| ROBERT A. BORNSTEIN, PH.D. NONE | Other services; Direct payment from the plan Service code 49 | 495 TUCKER DRIVE WORTHINGTON, OH 43085 | $184K |
| FLORIDA SPORTS INJURY EIN 45-2806834 NONE | Other services; Direct payment from the plan Service code 49 | — | $181K |
| SILVANA RIGGIO, M.D. NONE | Other services; Direct payment from the plan Service code 49 | 170 EAST 87TH STREET SUITE W20C NEW YORK, NY 10128 | $173K |
| JOSEPH CHAD HOYLE, M.D. NONE | Other services; Direct payment from the plan Service code 49 | 4166 BRYSON COVE CIRCLE DUBLIN, OH 43016 | $171K |
| SUTAPA MCNASBY, PH.D. NONE | Other services; Direct payment from the plan Service code 49 | 4703 CARLTON CROSSING DRIVE DURHAM, NC 27713 | $170K |
| DAVID F. APPLE JR., M.D. NONE | Other services; Direct payment from the plan Service code 49 | 2020 PEACHTREE ROAD NW ATLANTA, GA 30309 | $166K |
| MENORAH MEDICAL GROUP, LLC EIN 80-0609778 NONE | Other services; Direct payment from the plan Service code 49 | — | $162K |
| PAUL S. SAENZ, D.O., P.A. EIN 74-2613458 NONE | Other services; Direct payment from the plan Service code 49 | — | $155K |
| RAYMOND FABER, M.D. NONE | Direct payment from the plan; Other services Service code 49 | 11703 HUEBNER ROAD SUITE 106-273 SAN ANTONIO, TX 78230 | $144K |
| WILLIAM GARMOE, PH.D. NONE | Direct payment from the plan; Other services Service code 49 | 14300 GALLANT FOX LANE SUITE 107 BOWIE, MD 20715 | $142K |
| PEACHTREE ORTHOPEDIC CLINIC EIN 58-1080740 NONE | Other services; Direct payment from the plan Service code 49 | — | $138K |
| NEAL DEUTCH, PH.D. & ASSOCIATES EIN 48-1122260 NONE | Other services; Direct payment from the plan Service code 49 | — | $129K |
| ALL FLORIDA ORTHOPAEDIC ASSOCIATES EIN 59-2681990 NONE | Direct payment from the plan; Other services Service code 49 | — | $121K |
| CAROLINA HEADACHE INSTITUTE EIN 27-0823332 NONE | Other services; Direct payment from the plan Service code 49 | — | $118K |
| FONDREN ORTHOPEDIC GROUP, LLP EIN 76-0363583 NONE | Direct payment from the plan; Other services Service code 49 | — | $116K |
| MOIRA ARTIGUES, M.D. EIN 26-0552276 NONE | Direct payment from the plan; Other services Service code 49 | — | $113K |
| NICOLE WERNER, PH.D., LLC EIN 81-4319319 NONE | Direct payment from the plan; Other services Service code 49 | — | $112K |
| CALFIDUCIARY SERVICES, INC. EIN 47-5477044 NONE | Direct payment from the plan; Other services Service code 49 | — | $111K |
| DABDOUB LAW FIRM EIN 05-0585314 NONE | Direct payment from the plan; Other services Service code 49 | — | $110K |
| HERTZ CORPORATION EIN 13-1938568 NONE | Direct payment from the plan; Other services Service code 49 | — | $105K |
| AON EIN 22-2232264 NONE | Actuarial; Consulting (general); Direct payment from the plan Service code 11 | — | $103K |
| VIRGIL MEDLOCK III, M.D. NONE | Direct payment from the plan; Other services Service code 49 | 4408 LIVINGSTON AVE DALLAS, TX 75205 | $100K |
| ROBERT L. HEILBRONNER, PH.D. NONE | Direct payment from the plan; Other services Service code 49 | 333 N. MICHIGAN AVENUE SUITE 1801 CHICAGO, IL 60601 | $96K |
| KATHERINE BRIGGS BROWNLOWE, M.D. NONE | Direct payment from the plan; Other services Service code 49 | 2929 NORTH STAR ROAD UPPER ARLINGTON, OH 43221 | $94K |
| GREGORY MACK, M.D., INC. EIN 20-4015690 NONE | Other services; Direct payment from the plan Service code 49 | — | $83K |
| SAN DIEGO SPORTS MEDICINE & ORTHO. EIN 33-0834309 NONE | Direct payment from the plan; Other services Service code 49 | — | $83K |
| JONATHAN SCHLEIMER, M.D. NONE | Direct payment from the plan; Other services Service code 49 | 9850 GENESEE AVENUE #750 LA JOLLA, CA 92037 | $82K |
| MARK JORDAN TULLMAN, M.D. NONE | Direct payment from the plan; Other services Service code 49 | 20 FRONTENAC ESTATES DRIVE FRONTENAC, MO 63131 | $81K |
| PERRY ORTHO & SPORTS MEDICINE, P.A. EIN 56-2258322 NONE | Other services; Direct payment from the plan Service code 49 | — | $79K |
| EDWARD J. O'CONNOR, M.D., FAAN EIN 20-0579634 NONE | Direct payment from the plan; Other services Service code 49 | — | $79K |
| UNIVERSITY PHYSICIANS, INC. EIN 74-2161737 NONE | Direct payment from the plan; Other services Service code 49 | — | $79K |
| ALVIN DETTERLINE, M.D. NONE | Direct payment from the plan; Other services Service code 49 | 13905 FOXLAND ROAD PHOENIX, MD 21131 | $77K |
| BRENDAN JAMES KELLEY, M.D. NONE | Direct payment from the plan; Other services Service code 49 | 136 SAND POINT COURT COPPELL, TX 75019 | $75K |
| DOYLE PATTON, PH.D. EIN 20-2000235 NONE | Direct payment from the plan; Other services Service code 49 | — | $75K |
| DAVID CLARK, M.D. EIN 83-1863071 NONE | Direct payment from the plan; Other services Service code 49 | — | $73K |
| CENTER FOR ATHLETIC MEDICINE, LTD. EIN 36-3815402 NONE | Direct payment from the plan; Other services Service code 49 | — | $73K |
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 | 2,247 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2,034 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 6,406 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 10,687 | 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.