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 OF MICHIGAN EIN 38-2069753 N/A | Contract Administrator; Consulting (general); Other fees; Claims processing; Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue; Insurance services Service code 12 | — | $8.0M |
| CENTRAL STATES PENSION FUND EIN 36-6044243 N/A | Direct payment from the plan; Other services Service code 49 | — | $1.5M |
| PRUDENTRX, LLC EIN 84-4560702 N/A | Direct payment from the plan; Claims processing; Contract Administrator Service code 12 | — | $898K |
| DELTA DENTAL PLAN OF MICHIGAN, INC. EIN 38-1791480 N/A | Direct payment from the plan; Contract Administrator; Claims processing Service code 12 | — | $451K |
| WILLIS TOWERS WATSON US LLC EIN 53-0181291 N/A | Direct payment from the plan; Actuarial Service code 11 | — | $374K |
| KYLE STALLMAN EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $352K |
| ZELIS COST MANAGEMENT BUYER, INC EIN 84-2694744 N/A | Direct payment from the plan; Other services Service code 49 | — | $337K |
| CAREMARK EIN 95-3382344 N/A | Direct payment from the plan; Contract Administrator; Claims processing Service code 12 | — | $272K |
| WILLIAM DEIGHTON EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $221K |
| BRYAN CARNEY EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $189K |
| SANDY BOWMAN-CLAUS EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $169K |
| YOUNGSOFT, INC EIN 38-3274599 N/A | Direct payment from the plan; Other services Service code 49 | — | $169K |
| LAW OFFICES OF MICHAEL J. MILLS EIN 38-3043446 N/A | Legal; Direct payment from the plan Service code 29 | — | $159K |
| GAIL WILSON EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $155K |
| VISHAL SHARMA EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $153K |
| JASEN STAGNER EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $128K |
| TODD GRAHAM EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $127K |
| ELLIOTT QUICK EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $125K |
| HUA LI EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $123K |
| CYNTHIA BOETTNER EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $122K |
| MARK GUENTHER EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $121K |
| ERICA MILLER EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $117K |
| KENNETH MILLER EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $115K |
| DANIELLA JANCESKI EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $113K |
| CARLENE KNIGHT EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $105K |
| PATRICIA LAVIGNE EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $104K |
| AHMED YOUSSEF EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $101K |
| CAROL SHIREY EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $100K |
| SHERRYLN HALL EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $100K |
| MARISA FREEMAN EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $92K |
| DAWN LAWRENCE EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $91K |
| MDLIVE, INC EIN 45-4937055 N/A | Direct payment from the plan; Other services Service code 49 | — | $88K |
| LAKAYA CAGGINS EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $86K |
| JAKE WROBEL EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $84K |
| RSM US LLP EIN 42-0714325 N/A | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $84K |
| RAMONA FRANTZ EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $84K |
| ANDREW BRYER EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $83K |
| KELLY MIKOLAJEWSKI EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $83K |
| KRISTI CRONK EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $83K |
| KARIA WILLIAMS EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $81K |
| KATHLEEN TRENT EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $81K |
| MELANIE PARYASKI EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $81K |
| ANNE MEAD EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $80K |
| ANDREW MORRISON EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $79K |
| LAWRENCE STRAUGHEN EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $75K |
| JENNIFER HENDERSON EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $72K |
| KAREN SHASTACHUK EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $72K |
| ARIFAH MIRZA EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $71K |
| ROBIN SCHMIDT EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $69K |
| CHARLOTTE LEDBETTER EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $69K |
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 | 16,791 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 16,791 | 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.