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; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Participant communication; Contract Administrator; Recordkeeping fees Service code 12 | — | $86K |
| KPMG LLP EIN 13-5565207 PLAN AUDITOR | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $80K |
| EXPRESS SCRIPTS HOLDING COMPANY EIN 22-3461740 PHARMACY BENEFIT MANAGER | Contract Administrator; Recordkeeping fees; Direct payment from the plan; Claims processing; Other services; Participant communication; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $58K |
| THE NORTHERN TRUST COMPANY EIN 36-1561860 TRUSTEE & INV. ADVISOR | Investment management fees paid directly by plan; Other investment fees and expenses; Investment advisory (plan); Investment management; Trustee (bank, trust company, or similar financial institution); Direct payment from the plan; Float revenue; Other fees; Investment management fees paid indirectly by plan; Account maintenance fees; Trustee (directed) Service code 21 | — | $36K |
| WILLIS TOWERS WATSON EIN 26-0775680 RX COLLABORATIVE SPONSOR | Other fees; Other services; Direct payment from the plan Service code 49 | — | $25K |
| CROWE HORWATH LLP EIN 35-0921680 FINANCIAL STATEMENT PREP | Direct payment from the plan; Accounting (including auditing); Consulting (general) Service code 10 | — | $14K |
| BLUE CROSS BLUE SHIELD OF ALABAMA EIN 63-0103830 THIRD-PARTY ADMINISTRATO | Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Participant communication; Direct payment from the plan; Contract Administrator; Recordkeeping fees Service code 12 | — | $11K |
| PRIME THERAPEUTICS LLC EIN 26-0076803 PHARMACY BENEFIT MANAGER | Other services; Direct payment from the plan; Recordkeeping fees; Contract Administrator; Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Participant communication Service code 12 | — | $2K |
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 | 506 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 506 | 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.