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 23-9154168 NONE | Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Direct payment from the plan; Contract Administrator Service code 12 | — | $1.7M |
| TRI-STATE ADMINISTRATORS INC. EIN 22-3478819 NONE | Direct payment from the plan; Contract Administrator Service code 13 | — | $1.4M |
| HEALTHPLEX, INC. EIN 11-2714365 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $432K |
| AMERICAN HEALTH HOLDING, INC. EIN 31-1368946 NONE | Direct payment from the plan; Other services; Other fees Service code 49 | — | $186K |
| SCHULTHEIS & PANETTIERI, LLP EIN 13-1577780 ACCOUNTANT | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $92K |
| EXPRESS SCRIPTS, INC. EIN 22-3461740 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $86K |
| O'BRIEN, BELLAND & BUSHINSKY EIN 37-1467056 ATTORNEY | Legal; Direct payment from the plan Service code 29 | — | $68K |
| BRADY, MCGUIRE & STEINBERG PC EIN 13-4089943 NONE | Legal; Direct payment from the plan Service code 29 | — | $49K |
| INNOVATIVE SOFTWARE SOLUTIONS INC. EIN 23-2182079 NONE | Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $36K |
| ROBERT HALF INTERNATIONAL INC. EIN 94-1648752 NONE | Direct payment from the plan; Finders' fees / placement fees; Other services Service code 49 | — | $36K |
| VISION BENEFITS OF AMERICA INC. EIN 25-1149206 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $8K |
| CERTIFIED LANGUAGES INT'L. EIN 93-1220817 NONE | Participant communication; Direct payment from the plan Service code 38 | — | $6K |
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 | 9,839 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 9,839 | 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.