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 |
|---|---|---|---|
| EXPRESS SCRIPTS, INC. EIN 43-1420563 NONE | Contract Administrator; Claims processing Service code 12 | — | $195K |
| BLUE CROSS BLUE SHIELD OF IL EIN 36-1236610 NONE | Other insurance fees and expenses; Claims processing; Contract Administrator Service code 12 | — | $157K |
| AMERICAN HEALTHWAYS SERVICES LLC EIN 62-1216689 NONE | Contract Administrator; Claims processing Service code 12 | — | $115K |
| TOTAL ADMIN SERVICES CORP. EIN 39-1561025 NONE | Claims processing; Contract Administrator Service code 12 | — | $69K |
| IGNAZIA SURDYK EIN 36-2141153 EMPLOYEE | Employee (plan) Service code 30 | — | $46K |
| JOSEPH OHM EIN 36-2141153 EMPLOYEE | Employee (plan); Plan Administrator Service code 14 | — | $45K |
| ANGELA SMOLINSKI EIN 36-2141153 EMPLOYEE | Employee (plan) Service code 30 | — | $43K |
| SUZANNE MORRIN EIN 36-2141153 EMPLOYEE | Employee (plan) Service code 30 | — | $40K |
| GRACIELA DELGADO EIN 36-2141153 EMPLOYEE | Employee (plan) Service code 30 | — | $39K |
| ANNETTE KEYS EIN 36-2141153 EMPLOYEE | Employee (plan) Service code 30 | — | $38K |
| LANER MUCHIN, LTD. EIN 36-3088463 NONE | Legal Service code 29 | — | $35K |
| CONDUENT, INC. EIN 81-2983623 NONE | Consulting (general); Actuarial Service code 11 | — | $34K |
| HINES & ASSOCIATES, INC. EIN 36-3545085 NONE | Consulting (general) Service code 16 | — | $25K |
| CHANGE HEALTHCARE NONE | Consulting (general) Service code 16 | 55 W.MONROE, STE 1750 CHICAGO, IL 60603 | $24K |
| GREGORIO MARCO EIN 36-4028033 NONE | Legal Service code 29 | — | $24K |
| DELTA DENTAL OF ILLINOIS EIN 36-2612058 NONE | Claims processing; Contract Administrator Service code 12 | — | $22K |
| LEGACY PROFESSIONALS LLP EIN 32-0043599 NONE | Accounting (including auditing) Service code 10 | — | $15K |
| EYEMED VISION CARE LLC EIN 31-1656473 NONE | Contract Administrator; Claims processing Service code 12 | — | $14K |
| AMALGAMATED BANK OF CHICAGO EIN 36-0721895 NONE | Other investment fees and expenses; Float revenue; Custodial (securities) Service code 19 | — | $12K |
| SEGAL CONSULTING EIN 13-1975125 NONE | Consulting (general); Actuarial Service code 11 | — | $5K |
| STRATEGIC CAPITAL INV ADVISORS EIN 36-4268991 NONE | Investment advisory (plan) Service code 27 | — | $5K |
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 | 2,359 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 2,359 | 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.