No brokers reported on this filing.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EXCELLUS BCBS, ROCHESTER REGION EIN 15-0329043 NONE | Contract Administrator Service code 13 | — | $637K |
| YOUR BENEFITS RESOURCE (AON HEWITT) EIN 36-2235791 NONE | Contract Administrator Service code 13 | — | $452K |
| MVP HEALTH CARE EIN 14-1640868 NONE | Contract Administrator Service code 13 | — | $38K |
| MEDCO HEALTH SOLUTIONS, INC. EIN 22-3461740 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $28K |
| EBS-RMSCO, INC. EIN 16-1171765 TPA | Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Contract Administrator Service code 12 | — | $8K |
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 | 3,927 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 3,927 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | INDEPENDENT HEALTH | 45 | $649K |
| Prescription drug | HEALTHNOW NEW YORK, INC. DBA BLUECROSS BLUESHIELD OF WESTERN NEW YORK | 16 | $191K |
| Other | HEALTHNOW NEW YORK, INC. DBA BLUECROSS BLUESHIELD OF WESTERN NEW YORK | 16 | $191K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 45 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.