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 |
|---|---|---|---|
| JOINT INDUSTRY BOARD EIN 13-0891035 PLAN ADMINISTRATOR | Plan Administrator; Direct payment from the plan Service code 14 | — | $3.4M |
| CRYSTAL SERVICES GROUP INC EIN 46-1450855 NONE | Direct payment from the plan; Other services Service code 49 | — | $126K |
| FOREST ELECTRIC CORP EIN 13-2931692 NONE | Other services; Direct payment from the plan Service code 49 | — | $82K |
| ELLENOFF GROSSMAN & SCHOLE LLP EIN 13-3643185 NONE | Legal; Direct payment from the plan Service code 29 | — | $55K |
| PROSKAUER ROSE LLP EIN 13-1840454 NONE | Legal; Direct payment from the plan Service code 29 | — | $41K |
| BP INTERIORS CORP EIN 84-5020455 NONE | Other services; Direct payment from the plan Service code 49 | — | $30K |
| INSIGHT NORTH AMERICA LLC EIN 82-0983489 NONE | Direct payment from the plan; Investment management Service code 28 | — | $16K |
| IMPERIAL BAG & PAPER CO LLC EIN 20-5963953 NONE | Other services; Direct payment from the plan Service code 49 | — | $9K |
| COHEN WEISS AND SIMON LLP EIN 13-1592323 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $7K |
| STATE STREET BANK & TRUST CO EIN 04-1867445 NONE | Other fees; Investment management; Direct payment from the plan Service code 28 | — | $339 |
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 | 1,169 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,169 | 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.