Filings through .
History & trajectory Charts need 2 or more years. This plan has 10 years on file. Pro shows premium, premium per covered life, covered lives and carrier and broker share for every year.
See pricingThe plan is self-funded and has no stop-loss carrier. A large claim hits the plan directly. Stop-loss carriers can pitch it.
Schedule A changed between filings. The plan moved between insured and self-funded, or contracts were added or removed. The plan is in a transition year.
The Schedule A insurance contracts show who carries the risk, for which benefits and for how many people.
No insurance carriers on this filing. Self-funded health and benefits plans typically pay TPAs and PBMs through Schedule C, not Schedule A.
These benefits are declared on the Form 5500 main form. A ✓ means the benefit also has a Schedule A insurance contract. Without one, plan assets or a Schedule C TPA fund the benefit.
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6,128 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 6,128 | Active, retired or separated, and beneficiaries. Dependents are not counted. |
This filing has no Schedule A insurance contracts. This is typical of fully self-funded plans. 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 instead of this filer's headcount. We show the row, but it does not count the people in this plan.
Brokers paid through Schedule A and service providers paid through Schedule C.
No brokers reported on this filing.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA INC. EIN 06-6033492 CONTRACT ADMINISTRATOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $154K |
| UMR, INC. EIN 39-1995276 CONTRACT ADMINISTRATOR | Contract Administrator; Direct payment from the plan Service code 13 | — | $75K |
| BDO USA, P.C. EIN 13-5381590 AUDITOR | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $54K |
| QUANTUM HEALTH, INC. EIN 20-8423895 CONTRACT ADMINISTRATOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $39K |
| DELTA DENTAL INSURANCE COMPANY EIN 94-2761537 CONTRACT ADMINISTRATOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $16K |
| JP MORGAN CHASE EIN 13-4994650 TRUSTEE | Direct payment from the plan; Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $8K |
This section shows how the plan is funded and what that means for risk.
Welfare charges, retention and retention rate (the carrier margin on this plan) are on Pro.
6 contacts
Phone and email for the actuary and top hat administrator are on Pro.
10 filings · 2016 to 2025