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 |
|---|---|---|---|
| CORESOURCE, INC. EIN 35-1846036 THIRD-PARTY ADMINISTRATO | Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Contract Administrator; Participant communication; Recordkeeping fees; Claims processing Service code 12 | — | $89K |
| EXPRESS SCRIPTS HOLDING COMPANY EIN 22-3461740 PHARMACY BENEFIT MANAGER | Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Participant communication; Contract Administrator; Recordkeeping fees; Direct payment from the plan Service code 12 | — | $73K |
| THE NORTHERN TRUST COMPANY EIN 36-1561860 TRUSTEE & INV. ADVISOR | Investment management; Trustee (bank, trust company, or similar financial institution); Account maintenance fees; Investment management fees paid indirectly by plan; Float revenue; Investment management fees paid directly by plan; Other fees; Trustee (directed); Direct payment from the plan; Other investment fees and expenses Service code 21 | — | $31K |
| TOWERS WATSON CO EIN 26-0775680 RX COLLABORATIVE SPONSOR | Direct payment from the plan; Other services; Other fees Service code 49 | — | $17K |
| BLUE CROSS BLUE SHIELD OF ALABAMA EIN 63-0103830 THIRD-PARTY ADMINISTRATO | Contract Administrator; Participant communication; Direct payment from the plan; Recordkeeping fees; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing Service code 12 | — | $13K |
| PRIME THERAPEUDICS LLC EIN 26-0076803 PHARMACY BENEFIT MANAGER | Recordkeeping fees; Participant communication; Direct payment from the plan; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Float revenue Service code 12 | — | $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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 528 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 528 | 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.