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 |
|---|---|---|---|
| EXPRESS SCRIPTS PRESCRIPTION SERVICES | Other fees Service code 99 | 1 EXPRESS WAY ST. LOUIS, MO 63121 | $123K |
| SOUTHERN BENEFITS ADMINISTRATOR INC EIN 59-6154877 PLAN ADMINISTRATOR | Plan Administrator Service code 14 | PO BOX 1449 GOODLETTSVILLE, TN 37070 | $118K |
| HCC LIFE INSURANCE STOP LOSS INSURANCE | Insurance services Service code 23 | 225 TOWNPARK DR, 350 213-660-1793 KENNESAW, GA 30144 | $107K |
| UMR MEDICAL CONSULTING | Actuarial Service code 11 | 115 W WAUSAU AVENUE WAUSAU, WI 54401 | $61K |
| UNITED MEMBERS INSURANCE FIDUCIARY & CYBER LIABILI | Insurance services Service code 23 | 6826 W LINEBAUGH AVE 813-265-2300 TAMPA, FL 33625 | $16K |
| UNITED HEALTHCARE -PPO PREFERRED PROVIDER SERVIC | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $7K |
| SOUTHERN BENEFIT ADMINISTRATOR, INC EIN 59-6154877 PREPARE REPORT | Actuarial Service code 11 | PO BOX 1449 GOODLETTSVILLE, TN 370701449 | $7K |
| UNITED ACTURIAL SERVICES, INC. ACTURIAL SERVICE | Actuarial Service code 11 | 11590 N MERIDIAN STREET 317-580-8670 CARMEL, IN 460324529 | $6K |
| SOUTHERN BENEFIT ADMINISTRATORS,INC EIN 59-6154877 COPYING, PRINTING & MAIL | Copying and duplicating Service code 36 | P.O. BOX 1449 GOODLETSVILLE, TN 370701449 | $3K |
| VENABLE LAW FIRM, PA EIN 59-1824867 PLAN'S ATTORNEY | Legal Service code 29 | 7402 N 56TH ST,SUITE 380 TAMPA, FL 33617 | $3K |
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 | 165 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 173 | 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."
No prospect flags tripped on this filing.