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 |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 NONE | Named fiduciary; Non-monetary compensation; Contract Administrator; Direct payment from the plan; Participant communication; Claims processing; Float revenue; Other services Service code 12 | P.O. BOX 644546 PITTSBURGH, PA 152644546 | $445K |
| BENESYS EIN 38-2383171 NONE | Consulting (general) Service code 16 | 700 TOWER DRIVE SUITE 300 TROY, MI 48098 | $118K |
| DANA CROUCH EIN 23-7017526 EMPLOYEE | Employee (plan) Service code 30 | 1996 BY-PASS SOUTH LAWRENCEBURG, KY 40342 | $105K |
| SAMANTHA J GRIFFIETH EIN 23-7017526 EMPLOYEE | Employee (plan) Service code 30 | — | $84K |
| ENVISION PHARMACEUTICAL SERVICES EIN 05-0570786 NONE | Claims processing Service code 12 | 2181 E. AURORA RD, STE 201 TWINSBURG, OH 44087 | $73K |
| BARBARA C WALKER EIN 23-7017526 EMPLOYEE | Employee (plan) Service code 30 | — | $57K |
| PNC FINANCIAL SERVICES GROUP EIN 22-1146430 NONE | Trustee (discretionary) Service code 24 | 500 W. JEFFERSON STREET LOUISVILLE, KY 40202 | $55K |
| JENNIFER WILHITE EIN 23-7017526 EMPLOYEE | Employee (plan) Service code 30 | — | $54K |
| PAULA M DRISCOLL EIN 23-7017526 EMPLOYEE | Employee (plan) Service code 30 | — | $54K |
| LESLEY OSBORNE EIN 23-7017526 EMPLOYEE | Employee (plan) Service code 30 | — | $53K |
| RHONDA K ANDERSON EIN 23-7017526 EMPLOYEE | Employee (plan) Service code 30 | — | $53K |
| KAREN B COONTZ EIN 23-7017526 EMPLOYEE | Employee (plan) Service code 30 | — | $50K |
| MCM CPAS & ADVISORS LLP EIN 27-1235638 NONE | Accounting (including auditing) Service code 10 | 462 S. FOURTH STREET, STE 2600 LOUISVILLE, KY 40202 | $39K |
| ELAINE B JANDIS EIN 23-7017526 EMPLOYEE | Employee (plan) Service code 30 | — | $37K |
| JESSICA G SHACKELFORD EIN 23-7017526 EMPLOYEE | Employee (plan) Service code 30 | — | $36K |
| JOHNSON & KROL NONE | Legal Service code 29 | 300 S. WACKER STREET CHICAGO, IL 60606 | $34K |
| NETCOMM EIN 61-1239035 NONE | Consulting (general) Service code 16 | 3070 HARRODSBURG RD LEXINGTON, KY 40503 | $33K |
| BERGER & BERGER EIN 35-1281454 NONE | Legal Service code 29 | 313 MAIN STREET EVANSVILLE, IN 47708 | $23K |
| DEBBIE L WALKER EIN 23-7017526 EMPLOYEE | Employee (plan) Service code 30 | — | $22K |
| UNITED ACTUARIAL SERVICES, INC. EIN 35-2156428 NONE | Actuarial Service code 11 | 11590 N. MERIDIAN ST, SUITE 610 CARMEL, IN 46032 | $11K |
| CIGNA | Non-monetary compensation; Contract Administrator; Direct payment from the plan; Participant communication; Claims processing; Float revenue; Named fiduciary; Other services Service code 12 | — | $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 | 1,660 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 245 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,905 | 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.