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 |
|---|---|---|---|
| SOUTHERN BENEFIT ADMINISTRATORS EIN 62-1116095 NONE | Plan Administrator Service code 14 | P.O. BOX 1449 GOODLETTSVILLE, TN 370701449 | $302K |
| DANIELS, IRWIN & AYLOR EIN 62-1802605 NONE | Accounting (including auditing) Service code 10 | 223 MADISON ST STE 112 MADISON, TN 371153602 | $17K |
| BARRETT JOHNSTON MARTIN & GARRISON EIN 62-1435459 NONE | Legal Service code 29 | 414 UNION ST STE 900 NASHVILLE, TN 37219 | $12K |
| SYNOVUS NONE | Trustee (bank, trust company, or similar financial institution) Service code 21 | PO BOX 2646-R 800-334-9007 COLUMBUS, GA 31902 | $7K |
| CIGNA EIN 06-0303370 NONE | Claims processing Service code 12 | 1111 MARKET ST CHATTANOOGA, TN 37402 | $6K |
| UBS FINANCIAL SERVICES EIN 13-2638166 NONE | Investment management Service code 28 | 3102 WEST END AVE 500 NASHVILLE, TN 37203 | $74 |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 724 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 724 | 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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.