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 |
|---|---|---|---|
| ANTHEM HEALTH PLANS OF VIRGINIA, IN EIN 54-0357120 THIRD-PARTY ADMINISTRATO | Other services; Claims processing; Contract Administrator; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 12 | — | $116K |
| KPMG LLP EIN 13-5565207 PLAN AUDITOR | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $71K |
| WILLIS TOWERS WATSON EIN 26-0776803 RX COLLABORATIVE FEES | Direct payment from the plan; Other fees; Other services Service code 49 | — | $51K |
| THE NORTHERN TRUST COMPANY EIN 36-1561860 TRUSTEE, INV. ADV. & MGR | Investment advisory (plan); Investment management; Direct payment from the plan; Other investment fees and expenses; Float revenue; Trustee (directed); Account maintenance fees; Trustee (bank, trust company, or similar financial institution); Investment management fees paid directly by plan; Other fees Service code 21 | — | $48K |
| EXPRESS SCRIPTS, INC. EIN 22-3461740 PHARMACY BENEFIT MANAGER | Participant communication; Recordkeeping fees; Direct payment from the plan; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Claims processing Service code 12 | — | $45K |
| CROWE LLP EIN 35-0921680 FINANCIAL STATEMENT PREP | Consulting (general); Accounting (including auditing); Direct payment from the plan Service code 10 | — | $10K |
| EY EIN 34-6565596 TAX FORM PREPARER | Consulting (general); Direct payment from the plan Service code 16 | — | $6K |
| AON CONSULTING, INC. EIN 22-2232264 FORM 5500 PREPARER | Direct payment from the plan; Consulting (general) Service code 16 | — | $5K |
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 | 401 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 401 | 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.