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 |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD EIN 36-1236610 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $17.4M |
| CITIZENS RX, LLC EIN 27-2485135 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $4.0M |
| DELTA DENTAL OF ILLINOIS EIN 36-2612058 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $1.6M |
| PDC NO. 30 PENSION FUND EIN 36-6191120 RELATED PARTY | Plan Administrator; Direct payment from the plan Service code 14 | — | $773K |
| INETICO, LLC DBA VALENZ CARE EIN 36-4869660 NONE | Other services; Direct payment from the plan Service code 49 | — | $321K |
| VISION SERVICE PLAN EIN 20-0891619 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $220K |
| PDC NO. 30 EIN 36-1861338 RELATED PARTY | Other services; Direct payment from the plan Service code 49 | — | $180K |
| MACNELL ACCOUNTING & CONSULTING,LLP EIN 30-0510353 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $160K |
| PAYDHEALTH, LLC EIN 84-2853707 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $119K |
| BUCK GLOBAL, LLC EIN 13-3954297 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $94K |
| TEAM CORPORATION EIN 81-4050818 NONE | Direct payment from the plan; Other services Service code 49 | — | $75K |
| BRIDGEWAY BENEFIT TECHNOLOGIES, LLC EIN 52-1796473 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $68K |
| PDC NO. 30 LMIDF EIN 32-0233172 RELATED PARTY | Direct payment from the plan; Other services Service code 49 | — | $61K |
| NATIONAL INVESTMENT SVCS OF AMERICA EIN 84-3937993 NONE | Investment management; Direct payment from the plan Service code 28 | — | $43K |
| EPLAN LLC EIN 20-3720767 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $37K |
| ACCRETIVE GLOBAL INUSRANCE SERVICES EIN 85-3689655 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $30K |
| STRATEGIC CAPITAL INVEST. ADVISOR EIN 36-4268991 NONE | Direct payment from the plan; Investment advisory (plan) Service code 27 | — | $24K |
| JACOBS, BURNS, ORLOVE & HERNANDEZ EIN 36-2425981 NONE | Legal; Direct payment from the plan Service code 29 | — | $14K |
| GREEN LIGHT COST MANAGEMENT LLC EIN 45-5248276 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $10K |
| AURORA FASTPRINT NONE | Direct payment from the plan; Other services Service code 49 | 54 E. GALENA BLVD. AURORA, IL 60505 | $8K |
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 | 970 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 290 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,260 | 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.