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 |
|---|---|---|---|
| HEALTH CARE SERVICES CORP (BC/BS) EIN 36-1236610 NONE | Claims processing Service code 12 | 300 E RANDOLPH ST CHICAGO, IL 60601 | $794K |
| KEVIN SCHELL EIN 36-2356062 EMPLOYEE | Employee (plan) Service code 30 | 205 ALEXANDRA WAY CAROL STREAM, IL 60188 | $165K |
| DIANE PACHOLIK EIN 36-2356062 EMPLOYEE | Employee (plan) Service code 30 | 205 ALEXANDRA WAY CAROL STREAM, IL 60188 | $108K |
| DIANE HERDA EIN 36-2356062 EMPLOYEE | Employee (plan) Service code 30 | 205 ALEXANDRA WAY CAROL STREAM, IL 60188 | $108K |
| THE SEGAL COMPANY EIN 13-1975125 NONE | Actuarial; Consulting (general) Service code 11 | 101 N WACKER DR., STE 500 CHICAGO, IL 60606 | $101K |
| KELLIE COLLINS-TITTLE EIN 36-2356062 EMPLOYEE | Employee (plan) Service code 30 | 205 ALEXANDRA WAY CAROL STREAM, IL 60188 | $100K |
| JANICE SWARTZ EIN 36-2356062 EMPLOYEE | Employee (plan) Service code 30 | 205 ALEXANDRA WAY CAROL STREAM, IL 60188 | $100K |
| SAGE ADVISORY SERVICES EIN 74-2798841 NONE | Investment management Service code 28 | 5900 SOUTHWEST PARKWAY, BDG I, STE AUSTIN, TX 78735 | $94K |
| ERESTINE CIBOR EIN 36-2356062 EMPLOYEE | Employee (plan) Service code 30 | 205 ALEXANDRA WAY CAROL STREAM, IL 60188 | $94K |
| MARY MORRISON EIN 36-2356062 EMPLOYEE | Employee (plan) Service code 30 | 205 ALEXANDRA WAY CAROL STREAM, IL 60188 | $89K |
| JENNIFER WINGSTEDT EIN 36-2356062 EMPLOYEE | Employee (plan) Service code 30 | 205 ALEXANDRA WAY CAROL STREAM, IL 60188 | $87K |
| INNOVATIVE SOFTWARE SOLUTIONS INC. EIN 23-2182079 NONE | Consulting (general) Service code 16 | TWO EXECUTIVE CAMPUS, STE. 400 CHERRY HILL, NJ 08002 | $65K |
| ENVISION PHARMACEUTICAL SERVICES LL EIN 90-1011712 NONE | Claims processing Service code 12 | 2181 E AURORA RD, STE 201 TWINSBURG, OH 44087 | $64K |
| BAUM SIGMAN AUERBACH & NEUMAN EIN 36-2744057 NONE | Legal Service code 29 | 200 W ADAMS ST., SUITE 2200 CHICAGO, IL 60606 | $54K |
| MORGAN STANLEY/GRAYSTONE EIN 26-4310632 NONE | Investment advisory (plan); Direct payment from the plan; Securities brokerage; Custodial (securities); Consulting fees Service code 19 | 800 EAST 96TH STREET SUITE 400 INDIANAPOLIS, IN 46240 | $53K |
| CALIBRE CPA GROUP, PLLC EIN 47-0900880 NONE | Accounting (including auditing) Service code 10 | 230 W MONROE, STE 310 CHICAGO, IL 60606 | $49K |
| MEDCARE MANAGEMENT EIN 88-0429522 NONE | Other services Service code 49 | 2090 PALM BEACH LAKES BLVD, STE 900 WEST PALM BEACH, FL 33409 | $38K |
| EMPLOYEE RESOURCE SYSTEMS EIN 36-3867645 NONE | Consulting (general) Service code 16 | 29 E. MADISON ST., STE 1600 CHICAGO, IL 60602 | $26K |
| BOND BROTHERS EIN 36-2433269 NONE | Copying and duplicating Service code 36 | 7826 47TH ST. LYONS, IL 60534 | $17K |
| DENTAL NETWORK OF AMERICA EIN 36-3339483 NONE | Claims processing Service code 12 | 300 E RANDOLPH ST CHICAGO, IL 60601 | $15K |
| DATAMATION IMAGING SERVICES EIN 36-4303011 NONE | Copying and duplicating Service code 36 | 7700 GRIFFIN WAY B WILLOWBROOK, IL 60527 | $8K |
| EYE MED EIN 31-1656473 NONE | Claims processing Service code 12 | 4000 LUXOTTICA PLACE MASON, OH 45040 | $6K |
| COMERICA EIN 42-1741646 NONE | Custodial (securities) Service code 19 | 411 W. LAFAYETTE AVE DETROIT, MI 48226 | $2K |
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 | 1,250 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 602 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,852 | 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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.