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 | — | $1.8M |
| ALERE TOXICOLOGY SERVICES, INC EIN 72-0846066 NONE | Other services; Contract Administrator Service code 13 | — | $509K |
| DALE BRANSCUM II EIN 48-1069941 ADMINISTRATOR | Employee (plan); Plan Administrator Service code 14 | — | $385K |
| CLEMENT SMARRA EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $258K |
| BRIDGET CONNORS EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $246K |
| JAY BROPHY EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $215K |
| REBECCA BURCH EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $186K |
| CONVENTION SERVICES UNLIMITED EIN 52-2009500 NONE | Other services; Other fees Service code 49 | — | $170K |
| ATLAS MARKETING EIN 33-1197414 NONE | Direct payment from the plan; Other services Service code 49 | — | $141K |
| MARK GARRETT EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $113K |
| RACKSPACE HOSTING EIN 74-3219359 NONE | Direct payment from the plan; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $111K |
| REBECCA TIEBOUT EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $110K |
| NICOLE BENSON EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $93K |
| ELLEN MINTON EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $89K |
| HEIDI BISCHE EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $86K |
| US HEALTHWORKS MEDICAL GROUP EIN 58-2420844 NONE | Other services; Contract Administrator Service code 13 | — | $70K |
| ALLISON WITTMEYER EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $70K |
| JILL LUCKERT EIN 48-1069941 EMPLOYEE | Employee (plan) Service code 30 | — | $56K |
| AMERICAN INDUSTRIAL CARE EIN 68-0405977 NONE | Other services; Contract Administrator Service code 13 | — | $55K |
| TECHNOLOGY SOLUTIONS GROUP, INC. EIN 48-1203842 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services; Direct payment from the plan Service code 15 | — | $53K |
| BLAKE & UHLIG, PA EIN 48-0918231 NONE | Legal; Direct payment from the plan Service code 29 | — | $50K |
| WIDE AWAKE FILMS, LLC EIN 84-1551457 NONE | Other services Service code 49 | — | $34K |
| MERCY ST. VINCENT OCC HEALTH EIN 34-4428250 NONE | Contract Administrator; Other services Service code 13 | — | $34K |
| COLSTRIP MEDICAL CENTER EIN 81-0484738 NONE | Other services; Contract Administrator Service code 13 | — | $32K |
| LEGACY PROFESSIONALS LLP EIN 32-0043599 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $31K |
| BOILERMAKER NATIONAL PENSION TRUST EIN 48-6168020 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 15 | — | $31K |
| BANK OF LABOR EIN 48-0150325 NONE | Custodial (securities); Direct payment from the plan Service code 19 | — | $19K |
| OCCUPATIONAL HEALTH SERVICES EIN 04-3294497 NONE | Other services; Contract Administrator Service code 13 | — | $17K |
| NORTHWEST OHIO URGENT CARE EIN 34-1969814 NONE | Other services; Contract Administrator Service code 13 | — | $16K |
| CHERRY HILL SAFETY SERVICES NONE | Contract Administrator; Other services Service code 13 | P.O. BOX 443 PENN RUN, PA 15765 | $15K |
| MIDWEST OCCUPATIONAL MEDICINE LTD EIN 37-1370846 NONE | Other services; Contract Administrator Service code 13 | — | $15K |
| MERCY ST. CHARLES OCCUPATIONAL HEAL EIN 34-4445373 NONE | Other services; Contract Administrator Service code 13 | — | $14K |
| NURSING CORPS EIN 34-1964117 NONE | Other services; Contract Administrator Service code 13 | — | $13K |
| INCARE HEALTH SOLUTIONS LLC EIN 45-1566080 NONE | Other services; Contract Administrator Service code 13 | — | $12K |
| DR. FRED J. VON STEIFF EIN 94-2689195 NONE | Other services; Contract Administrator Service code 13 | — | $12K |
| CONCENTRA MEDICAL CENTERS NONE | Other services; Contract Administrator Service code 13 | P.O. BOX 20127 CRANSTON, RI 02920 | $11K |
| AMERISTAT MEDICAL STAFFING, LLC EIN 90-0930539 NONE | Other services; Contract Administrator Service code 13 | — | $10K |
| SEGAL MARCO ADVISORS EIN 13-2646110 NONE | Direct payment from the plan; Investment advisory (plan) Service code 27 | — | $10K |
| CHICAGOLAND DRUG TESTING EIN 37-1570596 NONE | Other services; Contract Administrator Service code 13 | — | $9K |
| VIRTUAL IMAGING, INC. EIN 43-1786115 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan; Other services Service code 15 | — | $9K |
| ACCU-SCREEN INC. EIN 48-1114201 NONE | Other services; Contract Administrator Service code 13 | — | $8K |
| FRESH APPROACH CLEANING SERVICES EIN 48-1047974 NONE | Other fees; Other services Service code 49 | — | $8K |
| GREAT LAKES BIOMEDICAL, LTD. EIN 32-0097884 NONE | Contract Administrator; Other services Service code 13 | — | $8K |
| EMSI, INC. NONE | Other services; Contract Administrator Service code 13 | P.O. BOX 202669 DALLAS, TX 75320 | $8K |
| TOMO DRUG TESTING EIN 20-5980955 NONE | Other services; Contract Administrator Service code 13 | — | $8K |
| ANYWHERE ANALYSIS NONE | Contract Administrator; Other services Service code 13 | 831 W. COMMERCE STR BUFFALO, TX 75831 | $8K |
| SKYLINE DISPLAYS HEARTLAND NONE | Other services; Direct payment from the plan Service code 49 | 9511 LEGLER ROAD LENEXA, KS 66219 | $7K |
| OCCUHEALTH EIN 34-4428256 NONE | Contract Administrator; Other services Service code 13 | — | $7K |
| LIMA MEMORIAL HEALTH SYSTEM NONE | Other services; Contract Administrator Service code 13 | P.O. BOX 932830 CLEVELAND, OH 44193 | $7K |
| ACCU-MED LABS INC. EIN 45-3134825 NONE | Contract Administrator; Other services 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 | 42,059 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 42,059 | 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.