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 | Direct payment from the plan; Claims processing; Other fees; Insurance services; Contract Administrator; Consulting (general); Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue Service code 12 | — | $7.7M |
| CENTRAL STATES PENSION FUND EIN 36-6044243 N/A | Other services; Direct payment from the plan Service code 49 | — | $1.5M |
| PRUDENTRX, LLC EIN 84-4560702 N/A | Claims processing; Direct payment from the plan; Contract Administrator Service code 12 | — | $972K |
| BASYS, INC EIN 52-1796473 N/A | Other services; Direct payment from the plan Service code 49 | — | $594K |
| DELTA DENTAL PLAN OF MICHIGAN, INC. EIN 38-1791480 N/A | Contract Administrator; Claims processing; Direct payment from the plan Service code 12 | — | $458K |
| WILLIS TOWERS WATSON US LLC EIN 53-0181291 N/A | Direct payment from the plan; Actuarial Service code 11 | — | $350K |
| KYLE STALLMAN EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $348K |
| ZELIS PAYMENTS HOLDINGS, LLC DBA RE EIN 84-3069529 N/A | Direct payment from the plan; Other services Service code 49 | — | $323K |
| AMAZON WEB SERVICES, INC EIN 20-4938068 N/A | Other services; Direct payment from the plan Service code 49 | — | $256K |
| CAREMARK EIN 95-3382344 N/A | Contract Administrator; Claims processing; Direct payment from the plan Service code 12 | — | $239K |
| WILLIAM DEIGHTON EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $215K |
| BRYAN CARNEY EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $186K |
| PATRICIA LAVIGNE EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $184K |
| SANDY BOWMAN-CLAUS EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $165K |
| YOUNGSOFT, INC EIN 38-3274599 N/A | Other services; Direct payment from the plan Service code 49 | — | $157K |
| DATA PARTNERS INC EIN 38-3747818 N/A | Direct payment from the plan; Other services Service code 49 | — | $155K |
| VISHAL SHARMA EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $153K |
| GAIL WILSON EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $150K |
| MDX MEDICAL, LLC EIN 26-3441881 N/A | Contract Administrator; Direct payment from the plan; Claims processing Service code 12 | — | $147K |
| LAW OFFICES OF MICHAEL J. MILLS EIN 38-3043446 N/A | Legal; Direct payment from the plan Service code 29 | — | $146K |
| JASEN STAGNER EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $124K |
| ELLIOTT QUICK EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $121K |
| HUA LI EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $119K |
| CYNTHIA BOETTNER EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $118K |
| MARK GUENTHER EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $117K |
| ERICA MILLER EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $115K |
| KENNETH MILLER EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $112K |
| TODD GRAHAM EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $111K |
| ALLIED UNION SERVICES EIN 38-3316602 N/A | Other services; Direct payment from the plan Service code 49 | — | $107K |
| ZELIS COST MANAGEMENT BUYER, INC EIN 84-2694744 N/A | Other services; Direct payment from the plan Service code 49 | — | $103K |
| CARLENE KNIGHT EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $102K |
| CONTINENTAL CASUALTY COMPANY EIN 36-2114545 N/A | Insurance services; Direct payment from the plan Service code 23 | — | $98K |
| CAROL SHIREY EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $97K |
| SHERRYLN HALL EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $96K |
| AHMED YOUSSEF EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $93K |
| MARISA FREEMAN EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $89K |
| DAWN LAWRENCE EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $89K |
| GDI SERVICES INC EIN 39-2079800 N/A | Other services; Direct payment from the plan Service code 49 | — | $88K |
| RSM US LLP EIN 42-0714325 N/A | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $85K |
| STEVE HARBRON EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $84K |
| RAMONA FRANTZ EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $84K |
| LAKAYA CAGGINS EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $83K |
| JAKE WROBEL EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $81K |
| KRISTI CRONK EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $81K |
| ANDREW BRYER EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $80K |
| KELLY MIKOLAJEWSKI EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $80K |
| MELANIE PARYASKI EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $79K |
| KARIA WILLIAMS EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $78K |
| MDLIVE, INC EIN 45-4937055 N/A | Other services; Direct payment from the plan Service code 49 | — | $78K |
| KATHLEEN TRENT EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $76K |
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 | 17,062 | 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) | 17,062 | 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.