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 | Contract Administrator; Other fees Service code 13 | — | $1.9M |
| ALERE TOXICOLOGY SERVICES, INC EIN 72-0846066 NONE | Other services; Contract Administrator Service code 13 | — | $479K |
| BRIDGET CONNORS EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $259K |
| DALE BRANSCUM II EIN 48-1069941 ADMINISTRATOR | Employee (plan); Plan Administrator Service code 14 | — | $258K |
| CLEMENT SMARRA EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $256K |
| JAY BROPHY EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $237K |
| ATLAS MARKETING EIN 33-1197414 NONE | Other services; Direct payment from the plan Service code 49 | — | $195K |
| REBECCA BURCH EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $177K |
| CONVENTION SERVICES UNLIMITED EIN 52-2009500 NONE | Other services; Other fees Service code 49 | — | $177K |
| MARK GARRETT EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $109K |
| RACKSPACE HOSTING NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Direct payment from the plan Service code 15 | 1 FANATICAL PLACE, CITY OF WINDCRES SAN ANTONIO, TX 78218 | $108K |
| REBECCA TIEBOUT EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $106K |
| ROGER ERICKSON EIN 48-1069941 ADMINISTRATOR | Plan Administrator; Employee (plan) Service code 14 | — | $95K |
| NICOLE BENSON EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $87K |
| ELLEN MINTON EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $86K |
| HEIDI BISCHE EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $82K |
| US HEALTHWORKS MEDICAL GROUP EIN 58-2420844 NONE | Other services; Contract Administrator Service code 13 | — | $75K |
| BLAKE & UHLIG, PA EIN 48-0918231 NONE | Legal; Direct payment from the plan Service code 29 | — | $70K |
| ALLISON WITTMEYER EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $67K |
| TECHNOLOGY SOLUTIONS GROUP, INC. EIN 48-1203842 NONE | Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 15 | — | $62K |
| AMERICAN INDUSTRIAL CARE EIN 68-0405977 NONE | Contract Administrator; Other services Service code 13 | — | $58K |
| JILL LUCKERT EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $55K |
| LEGACY PROFESSIONALS LLP EIN 32-0043599 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $35K |
| MERCY ST. VINCENT OCC HEALTH EIN 34-4428250 NONE | Other services; Contract Administrator Service code 13 | — | $32K |
| VIRTUAL IMAGING, INC. EIN 48-1786115 NONE | Other services; Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $30K |
| 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 | — | $30K |
| NURSING CORPS EIN 34-1964117 NONE | Other services; Contract Administrator Service code 13 | — | $30K |
| COLSTRIP MEDICAL CENTER EIN 81-0484738 NONE | Other services; Contract Administrator Service code 13 | — | $30K |
| CODY LOHR EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $26K |
| MERCY ST. CHARLES OCCUPATIONAL HEAL EIN 34-4445373 NONE | Other services; Contract Administrator Service code 13 | — | $21K |
| MIDWEST OCCUPATIONAL MEDICINE LTD EIN 37-1370846 NONE | Other services; Contract Administrator Service code 13 | — | $21K |
| OCCUPATIONAL HEALTH SERVICES EIN 04-3294497 NONE | Other services; Contract Administrator Service code 13 | — | $20K |
| CONCENTRA MEDICAL CENTERS NONE | Other services; Contract Administrator Service code 13 | P.O. BOX 20127 CRANSTON, RI 02920 | $20K |
| DR. FRED J. VON STEIFF EIN 68-0405977 NONE | Contract Administrator; Other services Service code 13 | — | $19K |
| BANK OF LABOR EIN 48-0150325 NONE | Custodial (securities); Direct payment from the plan Service code 19 | — | $17K |
| MDMC INTERNAL MEDICINE EIN 43-0633449 NONE | Contract Administrator; Other services Service code 13 | — | $16K |
| WIDE AWAKE FILMS, LLC EIN 84-1551457 NONE | Other services Service code 49 | — | $16K |
| MOBILE MEDICAL CORPORATION EIN 25-1634174 NONE | Other services; Contract Administrator Service code 13 | — | $15K |
| AMERICAN FAMILY CARE, INC NONE | Other services; Contract Administrator Service code 13 | 3700 CAHABA BEACH ROAD BIRMINGHAM, AL 35242 | $13K |
| TOMO DRUG TESTING NONE | Contract Administrator; Other services Service code 13 | 2055 S. STEWART AVE., STE. A SPRINGFIELD, MO 65804 | $11K |
| NORTHWEST OHIO URGENT CARE EIN 34-1969814 NONE | Contract Administrator; Other services Service code 13 | — | $11K |
| MARCO CONSULTING GROUP, INC EIN 36-3555078 NONE | Direct payment from the plan; Investment advisory (plan) Service code 27 | — | $10K |
| GREAT LAKES BIOMEDICAL, LTD. EIN 32-0097884 NONE | Other services; Contract Administrator Service code 13 | — | $8K |
| EMSI, INC. NONE | Other services; Contract Administrator Service code 13 | P.O. BOX 202669 DALLAS, TX 75320 | $8K |
| LIMA MEMORIAL HEALTH SYSTEM NONE | Contract Administrator; Other services Service code 13 | P.O. BOX 932830 CLEVELAND, OH 44193 | $7K |
| UNION INSURANCE GROUP EIN 36-4226088 NONE | Insurance brokerage commissions and fees; Insurance services Service code 23 | — | $7K |
| PAYCHEX EIN 47-0900851 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 15 | — | $7K |
| REVEAL ONSITE, INC EIN 45-5208734 NONE | Contract Administrator; Other services Service code 13 | — | $7K |
| TRINITY TESTING SOLUTIONS EIN 51-6880166 NONE | Contract Administrator; Other services Service code 13 | — | $6K |
| AMERISTAT MEDICAL STAFFING, LLC EIN 90-0930539 NONE | Other services; Contract Administrator Service code 13 | — | $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 | 39,374 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 39,374 | 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.