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 |
|---|---|---|---|
| WABASH MEMORIAL HOSIPTAL ASSOCIATIO EIN 37-0806462 EMPLOYEE WAGES/BENEFITS | Employee (plan sponsor); Direct payment from the plan Service code 35 | — | $2.3M |
| BLUECROSS BLUESHIELD OF ILLINOIS EIN 36-1236610 CONTRACT ADMIN | Contract Administrator; Direct payment from the plan Service code 13 | — | $558K |
| HICKORY POINT BANK & TRUST FSB EIN 59-1531281 TRUST SERVICES | Trustee (bank, trust company, or similar financial institution); Direct payment from the plan Service code 21 | — | $106K |
| LDI, INC. EIN 43-0912223 PHARMACY BENEFIT MGR | Consulting (general); Direct payment from the plan Service code 16 | — | $106K |
| INNOVATIVE SOFTWARE SOLUTIONS EIN 23-2182079 IT CONSULTING | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 15 | — | $71K |
| CHANGE HEALTHCARE OPERATIONS, LLC EIN 20-5731067 CLAIMS PROCESSING | Claims processing; Direct payment from the plan Service code 12 | — | $61K |
| AMERICAN HEALTH HOLDING EIN 31-1368946 CONTRACT ADMIN | Direct payment from the plan; Contract Administrator Service code 13 | — | $58K |
| BKD, LLP EIN 44-0160260 AUDITOR | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $57K |
| FAEGRE BAKER DANIELS EIN 41-0244008 ATTORNEY | Legal; Direct payment from the plan Service code 29 | — | $41K |
| PREFERRED NETWORK ACCESS EIN 36-4018433 CONTRACT ADMIN | Direct payment from the plan; Contract Administrator Service code 13 | — | $26K |
| GAY ROLOFSON JANITORIAL SERVICE | Direct payment from the plan; Custodial (other than securities) Service code 18 | 1501 N. DECATUR STREET DECATUR, IL 62526 | $18K |
| TRUMP DIRECT EIN 37-1058364 PRINTER | Participant communication; Copying and duplicating; Direct payment from the plan Service code 36 | — | $14K |
| DAVID GREGORY CONTRACT PHYSICIAN | Direct payment from the plan; Other services Service code 49 | 1501 N. WATER STREET DECATUR, IL 62526 | $7K |
| COMMERCIAL MAIL SERVICE EIN 37-1324810 MAIL SERVICE | Direct payment from the plan; Participant communication Service code 38 | — | $6K |
| MED CARE MANAGEMENT EIN 88-0429522 CONTRACT ADMIN | Claims processing; Direct payment from the plan Service code 12 | — | $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 | 1,607 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2,112 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 3,719 | 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.