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 |
|---|---|---|---|
| EMPIRE HEALTHCHOICE ASSURANCE INC EIN 23-7391136 NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Claims processing Service code 12 | — | $4.4M |
| TRI-STATE ADMINISTRATORS INC EIN 22-3478819 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $1.2M |
| UNITED HEALTHCARE INSURANCE CO. EIN 41-2014834 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $314K |
| EXPRESS SCRIPTS EIN 43-1420563 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $180K |
| O'BRIEN BELLAND & BUSHINSKY EIN 37-1467056 ATTORNEY | Legal; Direct payment from the plan Service code 29 | — | $128K |
| SCHULTHEIS & PANETTIERI LLP EIN 13-1577780 AUDITOR | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $111K |
| BRIDGEWAY BENEFIT TECHNOLOGIES EIN 52-1796473 NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $111K |
| ROBERT HALF INT'L INC EIN 94-1648752 NONE | Other services; Direct payment from the plan Service code 49 | — | $56K |
| CHEIRON INC. EIN 13-4215617 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $36K |
| BRADY MCGUIRE & STEINBERG PC EIN 13-4089943 NONE | Legal; Direct payment from the plan Service code 29 | — | $21K |
| MORGAN STANLEY SMITH BARNEY LLC EIN 20-8764829 NONE | Investment advisory (plan); Investment management fees paid directly by plan Service code 27 | — | $20K |
| VISION BENEFITS OF AMERICA INC EIN 25-1149206 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $12K |
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 | 10,825 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 10,825 | 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.