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 |
|---|---|---|---|
| ALLEGIANT RX EIN 02-6015031 NONE | Contract Administrator; Other fees; Consulting (general) Service code 13 | 51 GOFFSTOWN ROAD MANCHESTER, NH 03102 | $97K |
| EXPRESS SCRIPTS INC EIN 22-3461740 NONE | Direct payment from the plan; Contract Administrator; Other fees; Claims processing Service code 12 | — | $65K |
| OPTUM RX EIN 33-0441200 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $55K |
| THE SEGAL COMPANY INC EIN 13-1835864 NONE | Actuarial; Direct payment from the plan Service code 11 | — | $36K |
| ROBERT M. CHEVERIE & ASSOCIATES EIN 06-1335139 NONE | Legal; Direct payment from the plan Service code 29 | — | $27K |
| ZENITH AMERICAN SOLUTIONS, INC EIN 06-0811449 NONE | Contract Administrator; Direct payment from the plan; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 13 | — | $14K |
| S.M. ESPOSITO & COMPANY, P.C. EIN 06-1298465 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $9K |
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 | 3,533 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 15 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 3,548 | 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.