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 | Consulting (general); Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Other fees; Insurance services; Contract Administrator; Direct payment from the plan; Float revenue Service code 12 | — | $237K |
| PRUDENTRX, LLC EIN 84-4560702 N/A | Contract Administrator; Direct payment from the plan; Claims processing Service code 12 | — | $67K |
| CENTRAL STATES PENSION FUND EIN 36-6044243 N/A | Direct payment from the plan; Other services Service code 49 | — | $61K |
| CELESTE MOORE EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $48K |
| RENITA WHITE/CRENSHAW EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Employee (plan); Direct payment from the plan Service code 30 | — | $46K |
| KYLE STALLMAN EIN 38-1328578 EMPLOYEE OF PLAN ADMIN | Direct payment from the plan; Employee (plan) Service code 30 | — | $13K |
| DELTA DENTAL PLAN OF MICHIGAN, INC. EIN 38-1791480 N/A | Claims processing; Contract Administrator; Direct payment from the plan Service code 12 | — | $10K |
| YOUNGSOFT, INC EIN 38-3274599 N/A | Other services; Direct payment from the plan Service code 49 | — | $7K |
| BASYS, INC EIN 52-1796473 N/A | Other services; Direct payment from the plan Service code 49 | — | $6K |
| TOWERS WATSON DELAWARE, INC. EIN 53-0181291 N/A | Direct payment from the plan; Actuarial Service code 11 | — | $6K |
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 | 550 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 193 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 743 | 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.