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 |
|---|---|---|---|
| COMMON ARC CORP EIN 36-3595141 NONE | Other fees; Contract Administrator Service code 13 | — | $1.6M |
| ALERE TOXICOLOGY SERVICES, INC EIN 72-0846066 NONE | Contract Administrator; Other services Service code 13 | — | $422K |
| ROGER ERICKSON EIN 48-1069941 ADMINISTRATOR | Plan Administrator; Employee (plan) Service code 14 | — | $368K |
| ATLAS MARKETING EIN 33-1197414 NONE | Other services; Direct payment from the plan Service code 49 | — | $357K |
| CLEMENT SMARRA EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $249K |
| BRIDGET CONNORS EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $248K |
| ROMAN ALANIZ JR. EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $237K |
| JAY BROPHY EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $214K |
| REBECCA BURCH EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $177K |
| CONVENTION SERVICES UNLIMITED EIN 52-2009500 NONE | Other fees Service code 99 | — | $169K |
| MARK GARRETT EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $105K |
| REBECCA TIEBOUT EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $103K |
| US HEALTHWORKS MEDICAL GROUP EIN 58-2420844 NONE | Other services; Contract Administrator Service code 13 | — | $91K |
| ELLEN MINTON EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $90K |
| RACKSPACE HOSTING NONE | Other services; Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | 1 FANATICAL PLACE, CITY OF WINDCRES SAN ANTONIO, TX 78218 | $82K |
| NICOLE BENSON EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $82K |
| HEIDI BISCHE EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $79K |
| ALLISON WITTMEYER EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $64K |
| WIDE AWAKE FILMS, LLC EIN 84-1551457 NONE | Other services Service code 49 | — | $61K |
| BLAKE & UHLIG, PA EIN 48-0918231 NONE | Legal; Direct payment from the plan Service code 29 | — | $56K |
| AMERICAN INDUSTRIAL CARE EIN 68-0405977 NONE | Other services; Contract Administrator Service code 13 | — | $47K |
| JILL LUCKERT EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $41K |
| LEGACY PROFESSIONALS LLP EIN 32-0043599 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $33K |
| COLSTRIP MEDICAL CENTER EIN 81-0484738 NONE | Other services; Contract Administrator Service code 13 | — | $31K |
| WILLIAM WHITAKER EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $31K |
| TECHNOLOGY SOLUTIONS GROUP, INC. EIN 48-1203842 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Other services Service code 15 | — | $27K |
| BOILERMAKER NATIONAL PENSION TRUST EIN 48-0669346 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 15 | — | $26K |
| NURSING CORPS EIN 34-1964117 NONE | Contract Administrator; Other services Service code 13 | — | $24K |
| VIRTUAL IMAGING, INC. EIN 48-1786115 NONE | Direct payment from the plan; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $22K |
| MERCY ST. VINCENT OCC HEALTH EIN 34-4428250 NONE | Other services; Contract Administrator Service code 13 | — | $20K |
| BANK OF LABOR EIN 48-0150325 NONE | Custodial (securities); Direct payment from the plan Service code 19 | — | $17K |
| MIDWEST OCCUPATIONAL MEDICINE LTD EIN 37-1370846 NONE | Contract Administrator; Other services Service code 13 | — | $16K |
| MERCY ST. CHARLES OCCUPATIONAL HEAL NONE | Contract Administrator; Other services Service code 13 | P.O. BOX 636435 CINCINNATI, OH 45263 | $16K |
| NORTHWEST OHIO URGENT CARE EIN 34-1969814 NONE | Other services; Contract Administrator Service code 13 | — | $15K |
| MOBILE MEDICAL CORPORATION EIN 25-1634174 NONE | Other services; Contract Administrator Service code 13 | — | $14K |
| CONCENTRA MEDICAL CENTERS NONE | Contract Administrator; Other services Service code 13 | P.O. BOX 20127 CRANSTON, RI 02920 | $12K |
| INFORMATION PRODUCTS, INC. EIN 06-0967199 NONE | Contract Administrator; Other services Service code 13 | — | $12K |
| ANYWHERE ANALYSIS NONE | Contract Administrator; Other services Service code 13 | 831 W COMMERCE BUFFALO, TX 75831 | $12K |
| OCCUPATIONAL HEALTH SERVICES EIN 04-3294497 NONE | Contract Administrator; Other services Service code 13 | — | $11K |
| THE DRUG TEST CENTER EIN 46-2900276 NONE | Other services; Contract Administrator Service code 13 | — | $10K |
| MARCO CONSULTING GROUP EIN 36-3555078 NONE | Investment advisory (plan) Service code 27 | — | $10K |
| ACCU-MED LABS, LLC EIN 45-3134825 NONE | Other services; Contract Administrator Service code 13 | — | $10K |
| TRINITY TESTING SOLUTIONS EIN 51-6880166 NONE | Other services; Contract Administrator Service code 13 | — | $9K |
| GREAT LAKES BIOMEDICAL, LTD. EIN 32-0097884 NONE | Other services; Contract Administrator Service code 13 | — | $9K |
| EMPLOYEE SCREENING SERVICES, INC. EIN 20-5980955 NONE | Other services; Contract Administrator Service code 13 | — | $9K |
| ERICKSON, KERNELL, DERUSSEAU & KLEY EIN 91-2192497 NONE | Legal Service code 29 | — | $9K |
| LIMA MEMORIAL HEALTH SYSTEM NONE | Other services; Contract Administrator Service code 13 | P.O. BOX 932830 CLEVELAND, OH 44193 | $8K |
| CHICAGOLAND DRUG TESTING EIN 37-1570596 NONE | Contract Administrator; Other services Service code 13 | — | $7K |
| PAYCHEX EIN 47-0900851 NONE | Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $7K |
| EMSI, INC. NONE | Contract Administrator; Other services Service code 13 | P.O. BOX 202669 DALLAS, TX 75320 | $7K |
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 | 37,148 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 37,148 | 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."
No prospect flags tripped on this filing.