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 |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 AFFIL. OF PARTY IN INT. | Contract Administrator Service code 13 | — | $11.0M |
| CONDUENT HR SERVICES AFFIL. OF PARTY IN INT. | Plan Administrator Service code 14 | 500 PLAZA DRIVE SECAUCUS, NJ 07094 | $1.6M |
| EXPRESS SCRIPTS EIN 43-1420563 AFFIL. OF PARTY IN INT. | Contract Administrator Service code 13 | — | $1.4M |
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 AFFIL. OF PARTY IN INT. | Claims processing; Direct payment from the plan; Float revenue; Named fiduciary; Other services; Contract Administrator; Participant communication; Non-monetary compensation Service code 12 | — | $1.2M |
| RR DONNELLEY INC. EIN 42-4027878 NONE | Copying and duplicating Service code 36 | — | $403K |
| MAGELLAN HEALTHCARE INC EIN 52-2135463 AFFIL. OF PARTY IN INT. | Contract Administrator Service code 13 | — | $360K |
| PRICEWATERHOUSECOOPERS EIN 13-4008324 IND AUDITOR OF PLAN SPON | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $173K |
| COTIVITI HEALTHCARE EIN 46-0634974 NONE | Contract Administrator Service code 13 | — | $144K |
| RAWLINGS COMPANY EIN 31-1563156 NONE | Contract Administrator Service code 13 | — | $134K |
| BNY MELLON NONE | Trustee (bank, trust company, or similar financial institution) Service code 21 | 240 GREENWICH STREET NEW YORK, NY 10286 | $108K |
| MULTIPLAN, INC. EIN 95-3778850 NONE | Contract Administrator Service code 13 | — | $44K |
| KANTAR / TNS NONE | Other services Service code 49 | WARRENVILLE ROAD SUITE 400 LISLE, IL 60532 | $27K |
| ALLIED PRINTING SERVICES EIN 06-0642973 NONE | Contract Administrator Service code 13 | — | $22K |
| OPTUMINSIGHT EIN 41-1858498 NONE | Contract Administrator Service code 13 | — | $19K |
| EQUIAN EIN 27-1471112 NONE | Contract Administrator Service code 13 | — | $17K |
| WAGEWORKS NONE | Other services Service code 49 | PO BOX 224547 DALLAS, TX 75222 | $15K |
| SERVICE PRESS EIN 04-5709930 NONE | Contract Administrator Service code 13 | — | $12K |
| OMNICLAIM EIN 27-0062838 NONE | Contract Administrator Service code 13 | — | $12K |
| EQUICLAIM (AN EMDEON COMPANY) EIN 26-3014624 NONE | Contract Administrator Service code 13 | — | $9K |
| WILLIS TOWERS WATSON AFFIL. OF PARTY IN INT. | Other services; Other fees; Actuarial Service code 11 | SUITE 4100. 500 N. AKARD STREET. DALLAS, TX 75201 | $9K |
| CORVEL CORPORATION EIN 95-3382819 NONE | Contract Administrator Service code 13 | — | $7K |
| ORS EIN 62-1451147 NONE | Contract Administrator Service code 13 | — | $6K |
| VERINT AMERICAS INC. NONE | Other services Service code 49 | PO BOX 733596. DALLAS, TX 75373 | $4K |
| UNITED PARCEL SERVICES EIN 95-1732075 NONE | Other services Service code 49 | — | $3K |
| AMERICAN SPECIALTY HEALTH (ASH) EIN 33-0571188 NONE | Other services Service code 49 | — | $0 |
| AMPLIFON USA, INC. EIN 85-0437037 NONE | Other services Service code 49 | — | $0 |
| BANK OF AMERICA (LOCKBOX) EIN 94-1687665 NONE | Other services Service code 49 | — | $0 |
| BLOOMINGTON HOSPITAL EIN 35-1720796 NONE | Other services Service code 49 | — | $0 |
| BLOOMINGTON HOSPITAL OF ORANGE COUN EIN 35-2090919 NONE | Other services Service code 49 | — | $0 |
| CARECORE NATIONAL LLC D/B/A EVICORE EIN 46-4861112 NONE | Other services Service code 49 | — | $0 |
| CASTLIGHT HEALTH EIN 26-1989091 NONE | Other services Service code 49 | — | $0 |
| CITIBANK NA EIN 59-1031071 NONE | Other services Service code 49 | — | $0 |
| CLARK MEMORIAL HOSPITAL EIN 35-0944638 NONE | Other services Service code 49 | — | $0 |
| DAVIESS COMMUNITY HOSPITAL EIN 35-6001322 NONE | Other services Service code 49 | — | $0 |
| DEUTSCHE BANK EIN 13-4941247 NONE | Other services Service code 49 | — | $0 |
| FIFTH THIRD BANCORP EIN 31-0676865 NONE | Other services Service code 49 | — | $0 |
| FIT FOR LIFE (FORMALLY GAIAM) EIN 38-3983812 NONE | Other services Service code 49 | — | $0 |
| GIBSON GENERAL HOSPITAL EIN 35-0877575 NONE | Other services Service code 49 | — | $0 |
| GOOD SAMARITAN HOSPITAL EIN 35-6001532 NONE | Other services Service code 49 | — | $0 |
| GOSHEN GENERAL HOSPITAL EIN 35-6001540 NONE | Other services Service code 49 | — | $0 |
| GREENE COUNTY GENERAL HOSPITAL EIN 35-6001492 NONE | Other services Service code 49 | — | $0 |
| HOME HOSPITAL/LAFAYETTE HOME HOSPIT EIN 35-2056396 NONE | Other services Service code 49 | — | $0 |
| JASPER COUNTY HOSPITAL EIN 35-1404051 NONE | Other services Service code 49 | — | $0 |
| JPMORGAN CHASE EIN 13-4994650 NONE | Other services Service code 49 | — | $0 |
| LIVONGO EIN 26-3542036 NONE | Other services Service code 49 | — | $0 |
| LUXOTTICA (COLE MANAGED VISION) EIN 31-1656473 NONE | Other services Service code 49 | — | $0 |
| MARGARET MARY COMMUNITY HOSPITAL EIN 35-6067049 NONE | Other services Service code 49 | — | $0 |
| MEADOWS HOSPITAL EIN 35-1858510 NONE | Other services Service code 49 | — | $0 |
| MEDSOLUTIONS D/B/A EVICORE, INC EIN 62-1615395 NONE | Other services Service code 49 | — | $0 |
| MONROE HOSPITAL EIN 20-2069733 NONE | Other services Service code 49 | — | $0 |
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 | 43,437 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 43,437 | 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.