21-Exhibit I Retirees 2026 Census.xlsx

XLSX spreadsheet 405 KB Posted Mar 20, 2026

Attached to: District Wide Employee Benefit Services.
Solicitation number: RFP 099-2026
Issued by: St. Louis County, Missouri

About this file

Written by GovTribe AI · Mar 24, 2026

This is a census data exhibit file for the Saint Louis Public School (SLPS) District's District Wide Employee Benefit Services contract opportunity in Missouri. The file, titled "21-Exhibit I Retirees 2026 Census.xlsx," contains actuarial and demographic information on retired employees projected for 2026. This exhibit serves as supporting documentation for the RFP, which seeks qualified firms to provide comprehensive benefit plans for both active and retired employees, including medical and prescription drug coverage, employee assistance plans, wellness programs, dental and vision plans, life insurance, accidental death and dismemberment coverage, voluntary life insurance, long-term disability, and short-term disability. The census data is essential for prospective bidders to understand the scope and scale of the retiree population they would be serving under any awarded contract.

The retiree census data contained in this exhibit enables bidders to evaluate the costs and feasibility of providing benefits to SLPS's retired employee population as of 2026. This demographic and actuarial information is critical for pricing submissions and risk assessments, as bidders must account for the number, age distribution, and benefit utilization patterns of retirees when developing their proposals and cost estimates for the district's consideration.

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Instructions

EMPLOYEE BENEFITS CENSUS REQUEST

Grafana Labs
Renewal Date:	1/1/26

Template Guidelines

1. Please complete the Census tab for all Active, Eligible employees, Retirees and COBRA participants.

2. Do not delete, hide or change the order of columns or workbook sheets.

3. Do not rename column headers.

4. Copying and pasting is allowed, but please be sure to Paste Special as Values.

5. DO NOT PASTE OVER OR CHANGE THE AGE COLUMN.

6. Do not Freeze Panes.

7. Do not use formulas in any columns.

8. Use the KEY tab to determine the acceptable value for fields which have an array of responses. DO NOT CHANGE KEY VALUES.

9. Please remember to password protect this file before returning it to USI. Reach out to your USI contact if you require any assistance with password protection.

The columns/fields and allowable values/entries included in the Census tab are listed below.

Census tab Column/Field	Census tab Column/Field Definition	Sample Data
Employee ID	Required; alpha numeric. Please repeat the Employee ID for each dependent.	156a8e61f
Employee Last Name	Required if Employee ID is not populated; text. Please repeat the Employee Last Name for each dependent.	Doe
Employee First Name	Required if Employee Last Name is populated; text. Please repeat the Employee First Name for each dependent.	Jane
Employee Middle Initial	Optional; text. If provided, please repeat the Employee Middle Initial for each dependent.	J
Employee Status	Required, only populate for Employee; see KEY tab for list of acceptable values	Active
Member Type	Required for all rows; see KEY tab for list of acceptable values	Employee
Dependent Last Name	Required if Dependent First Name is populated; text	Doe
Dependent First Name	Required if Dependent Last Name is populated; text	John
Dependent Middle Initial	Optional for all rows; text	M
COBRA Date	Required, only populate for Employee if Employee Status = COBRA; date	1/1/2020
DOB	Required for all rows; date	1/1/1970
Age (DO NOT CHANGE)	Do not change; formula used as a "double-check" for date of birth.	51
Physical Sex Assigned at Birth	Required for all rows; acceptable values: M or F	F
Full Time/ Part Time	Optional, only populate for Employee; acceptable values: F or P	F
DOH	Optional, only populate for Employee; date	1/1/2020
Residence State	Required, only populate for Employee; 2-digit USPS State Abbreviation	CA
Residence Zip Code	Required, only populate for Employee; 5-digit or 9-digit USPS Zip Code	90731
Occupation/ Job Title	Required if Life and/or Disability coverages included, only populate for Employee; text	Administrator
Annual Base Salary	Required if Life and/or Disability coverages included, only populate for Employee; dollar amount	75000
Annual Bonuses	Optional, only populate for Employee; dollar amount	20000
Annual Commissions	Optional, only populate for Employee; dollar amount	20000
Medical Enrollment Tier	Required, only populate for Employee; see KEY tab for list of acceptable values	ESC
Medical Plan	Required for all rows; see KEY tab for list of acceptable values	Medical 1
Dental Enrollment Tier	Required, only populate for Employee; see KEY tab for list of acceptable values	ESC
Dental Plan	Required for all rows; see KEY tab for list of acceptable values	Dental 1
Vision Enrollment Tier	Required, only populate for Employee; see KEY tab for list of acceptable values	ESC
Vision Plan	Required for all rows; see KEY tab for list of acceptable values	Vision 1
Life Class	Required for all rows; see KEY tab for list of acceptable values	Class II
V Life Ee Election Amount	Required, if applicable; dollar amount	100000
V Life Sp Election Amount	Required, if applicable; dollar amount	15000
V Life Ch	Required; acceptable values: Y or N	Y
LTD Class	Required for all rows; see KEY tab for list of acceptable values	Class 1
STD Class	Required for all rows; see KEY tab for list of acceptable values	Class III

&"Calibri,Bold"&10 SBS Creatix, LLC &"Calibri,Bold"&10 SBS Creatix 2023 Census &"Calibri,Bold"&10Request Census: 6/9/2023

KEY

EMPLOYEE BENEFITS CENSUS REQUEST
Grafana Labs
Renewal Date :	1/1/26
Please use one of the following:	Employee Status
5e5a9af3-c331-49e7-60f9-08db678abf3f	Active
3488387	Active - LOA
JSON v1.0	COBRA
Template v1.0	Retiree
Please use one of the following:	Member Type
5e5a9af3-c331-49e7-60f9-08db678abf3f	Employee
3488387	Spouse/Partner
JSON v1.0	Child
Please use the abbreviation:	Enrollment Tiers	Abbreviation
	Employee	E
	Employee + Spouse	ES
	Employee + Partner	EP
	Employee + Child(ren)	EC
	Employee + Spouse + Child(ren)	ESC
	Employee + Partner + Child(ren)	EPC
	Coverage Elsewhere	CE
	Not Eligible	NE
	Pending	P
	Waived	W
Please use the Plan/Class Description or the Plan/Class Alias:	Plan / Class Description	Plan / Class Alias	Plan Type	Policy #	Carrier
	Medical PPO	PPO	Medical PPO	936726, 1700428	UHC
	Medical HSA	HSA	Medical PPO	936726, 1700428	UHC
	Medical Surest Co-Pay	Surest	Medical PPO	936726, 1700428	UHC Surest
	Dental PPO Base	Base Plan	Dental PPO	00027159, 00895320, 00897205, 250722-044609	Guardian
	Dental PPO Premium	Buy-Up Plan	Dental PPO	00027159, 00895320, 00897205, 250722-044609
	Vision	Vision	Vision	00027159, 00895320, 00897205, 250722-044609	Guardian
	Group Life	Group Life	Life and AD&D	00027159, 00895320, 00897205, 250722-044609	Guardian
	Vol Life	Vol Life	Voluntary Life	00027159, 00895320, 00897205, 250722-044609	Guardian
	Short Term Disability (STD)	Short Term Disability (STD)	Short Term Disability (STD)	00027159, 00895320, 00897205, 250722-044609	Guardian
	Long Term Disability (LTD)	Long Term Disability (LTD)	Long Term Disability (LTD)	00027159, 00895320, 00897205, 250722-044609	Guardian
	Note: If Member is not eligible for Plan / Class, please enter Not Eligible in Plan / Class column field on Census tab.

&"Calibri,Bold"&10 SBS Creatix, LLC &"Calibri,Bold"&10 SBS Creatix 2023 Census &"Calibri,Bold"&10Request Census: 6/9/2023

Census

COBRA Date	DOB	Age (DO NOT CHANGE)	Physical Sex Assigned at Birth	Full Time/ Part Time	DOH	Residence State	Residence Zip Code	Medical Enrollment Tier	Medical Plan (PPO/Surest/HSA)
3/1/2022	7/14/1961	62	F			MO	63119	RETIREE	UBU016
	12/30/35	87	F			MO	63130	RETIREE	UBA001
	3/10/51	72	F			MO	63021	RETIREE	UBA001
	5/30/45	78	F			MO	63115	RETIREE	UBA001
	4/25/36	87	F			MO	63121	RETIREE	UBA001
	5/2/42	81	F			MO	63121	RETIREE	UBA001
	3/2/43	80	F			MO	63112	RETIREE	UBA001
	2/24/30	93	M			MO	63123	RETIREE	UBA001
	4/11/33	90	F			MO	63123	RETIREE	UBA001
	6/9/34	89	F			MO	63137	RETIREE	UBA001
	6/29/61	62	F			MO	63136	RETIREE	UBA001
	11/21/40	83	F			MO	63033	RETIREE	UBA001
	10/15/44	79	F			MO	63104	RETIREE	UBA001
	2/8/33	90	F			MO	63117	RETIREE	UBA001
	7/4/39	84	F			MO	63033	RETIREE	UBA001
	8/5/37	86	F			MO	63130	RETIREE	UBA001
	12/22/40	82	M			MO	63147	RETIREE	UBA001
	5/10/34	89	F			MO	63136	RETIREE	UBA001
	12/4/39	83	F			TX	76301	RETIREE	UBA001
	4/30/51	72	F			MO	63109	RETIREE	UBA001
	10/23/40	83	F			MO	63107	RETIREE	UBA001
	1/10/36	87	M			MO	63107	RETIREE	UBA001
	5/26/30	93	F			MO	63367	RETIREE	UBA001
	5/21/37	86	F			MO	63034	RETIREE	UBA001
	9/10/48	75	F			MO	63103	RETIREE	UBA001
	11/28/37	86	F			MO	63130	RETIREE	UBA001
	7/8/47	76	F			MO	63119	RETIREE	UBA001
	1/23/35	88	F			MO	63136	RETIREE	UBA001
	7/21/42	81	F			MO	63033	RETIREE	UBA001
	5/4/37	86	F			MO	63121	RETIREE	UBA001
	1/3/31	92	F			MO	63132	RETIREE	UBA001
	11/10/28	95	F			MO	63119	RETIREE	UBA001
	10/20/40	83	F			MO	63017	RETIREE	UBA001
	7/6/45	78	F			MO	63144	RETIREE	UBA001
	10/24/48	75	F			MO	63107	RETIREE	UBA001
	6/24/55	68	F			MO	63130	RETIREE	UBA001
	8/26/51	72	F			MO	63109	RETIREE	UBA001
	10/22/43	80	M			MO	63136	RETIREE	UBA001
	3/15/34	89	M			MO	63379	RETIREE	UBA001
	12/23/44	78	M			MO	63119	RETIREE	UBA001
	3/10/41	82	F			IL	62002	RETIREE	UBA001
	1/31/48	75	F			MO	63132	RETIREE	UBA001
	4/18/39	84	F			MO	63114	RETIREE	UBA001
	11/19/53	70	F			MO	63115	RETIREE	UBA001
	4/6/31	92	F			MO	63108	RETIREE	UBA001
	10/6/30	93	F			MO	63130	RETIREE	UBA001
	8/11/36	87	F			TX	77084	RETIREE	UBA001
	3/27/35	88	M			MO	63128	RETIREE	UBA001
	9/23/42	81	M			MO	63121	RETIREE	UBA001
	7/8/27	96	F			MO	63112	RETIREE	UBA001
	8/23/40	83	F			MO	63040	RETIREE	UBA001
	3/14/39	84	M			MO	63129	RETIREE	UBA001
	7/30/49	74	F			MO	63112	RETIREE	UBA001
	9/27/36	87	M			MO	63113	RETIREE	UBA001
	6/11/47	76	F			MO	63137	RETIREE	UBA001
	8/11/34	89	F			MO	63136	RETIREE	UBA001
	6/14/30	93	F			MO	63117	RETIREE	UBA001
	6/29/43	80	F			MO	63122	RETIREE	UBA001
	10/21/50	73	F			MO	63044	RETIREE	UBA001
	2/4/49	74	F			MO	63112	RETIREE	UBA001
	4/21/56	67	F			MO	63108	RETIREE	UBA001
	1/29/39	84	M			MO	63104	RETIREE	UBA001
	11/16/61	62	F			MO	63110	RETIREE	UBA002
	10/3/61	62	F			MO	63033	RETIREE	UBA002
	9/3/64	59	F			MO	63143	RETIREE	UBA002
	7/1/61	62	M			MO	63130	RETIREE	UBA002
	11/28/61	62	F			MO	63033	RETIREE	UBA002
	12/18/61	61	F			MO	63017	RETIREE	UBA002
	1/12/62	61	F			MO	63130	RETIREE	UBA002
	11/2/70	53	F			MO	63132	RETIREE	UBA002
	6/24/61	62	M			MO	63110	RETIREE	UBA002
	8/28/59	64	F			MO	63114	RETIREE	UBA002
	4/14/61	62	F			MO	63125	RETIREE	UBA002
	6/7/61	62	M			IL	62207	RETIREE	UBA002
	7/18/66	57	M			MO	63020	RETIREE	UBA002
	12/3/69	53	F			MO	63011	RETIREE	UBA002
	9/7/61	62	F			MO	63034	RETIREE	UBA002
	7/7/61	62	F			MO	63301	RETIREE	UBA002
	10/7/64	59	F			IL	62221	RETIREE	UBA002
	5/31/63	60	M			NV	89121	RETIREE	UBA002
	9/3/65	58	M			IL	62221	RETIREE	UBA002
	6/19/44	79	M			MO	63011	RETIREE	UBA002
	10/21/48	75	F			MO	63146	RETIREE + SPOUSE	UBA003
	2/13/49	74	M
	8/19/46	77	M			TX	75570	RETIREE + SPOUSE	UBA003
	3/16/46	77	F
	6/17/64	59	F			IL	62208	RETIREE + SPOUSE	UBA004
	3/20/62	61	M
	9/15/42	81	M			MO	63136	RETIREE + FAM	UBA012
	12/17/04		F
	11/14/03		F
	7/20/12		M
	8/30/38	85	F			MO	63115	RETIREE	UBA015
	8/9/37	86	M			MO	63121	RETIREE	UBA015
	7/11/39	84	F			MO	65049	RETIREE	UBA015
	11/2/60	63	F			MO	63119	RETIREE	UBU001
	10/2/51	72	F			MO	63130	RETIREE	UBU001
	7/18/53	70	F			MO	63137	RETIREE	UBU001
	10/4/40	83	F			MO	63147	RETIREE	UBU001
	8/21/46	77	F			MO	63147	RETIREE	UBU001
	12/2/38	84	F			MO	63033	RETIREE	UBU001
	12/31/48	74	F			MO	63130	RETIREE	UBU001
	12/5/48	74	F			MO	63115	RETIREE	UBU001
	10/11/48	75	F			IN	46033	RETIREE	UBU001
	9/13/52	71	F			MO	63113	RETIREE	UBU001
	10/21/43	80	F			MO	63043	RETIREE	UBU001
	3/13/59	64	F			MO	63043	RETIREE	UBU001
	4/3/55	68	F			MO	63130	RETIREE	UBU001
	10/24/51	72	M			MO	63111	RETIREE	UBU001
	10/11/53	70	M			MO	63116	RETIREE	UBU001
	3/3/47	76	F			MN	55436	RETIREE	UBU001
	8/27/34	89	F			MD	21701	RETIREE	UBU001
	4/23/57	66	F			MO	63121	RETIREE	UBU001
	1/30/47	76	F			MO	63121	RETIREE	UBU001
	4/16/47	76	F			MO	63021	RETIREE	UBU001
	2/28/52	71	M			MO	63116	RETIREE	UBU001
	1/15/42	81	F			MO	63130	RETIREE	UBU001
	5/25/43	80	F			MO	63017	RETIREE	UBU001
	2/18/52	71	F			MO	63121	RETIREE	UBU001
	10/18/42	81	F			MO	63123	RETIREE	UBU001
	3/25/44	79	F			MO	63130	RETIREE	UBU001
	6/22/56	67	F			MO	63118	RETIREE	UBU001
	10/13/47	76	M			MO	63139	RETIREE	UBU001
	9/21/42	81	M			SC	29464	RETIREE	UBU001
	8/14/41	82	F			TX	75024	RETIREE	UBU001
	12/15/48	74	F			FL	33417	RETIREE	UBU001
	7/5/45	78	F			MO	63132	RETIREE	UBU001
	5/2/42	81	F			MO	63043	RETIREE	UBU001
	6/4/45	78	F			MO	63124	RETIREE	UBU001
	8/26/47	76	M			MO	63112	RETIREE	UBU001
	2/23/47	76	F			MO	63122	RETIREE	UBU001
	2/24/43	80	F			FL	33321	RETIREE	UBU001
	1/2/45	78	F			MO	63115	RETIREE	UBU001
	11/9/49	74	F			MO	63137	RETIREE	UBU001
	3/22/50	73	F			MO	63112	RETIREE	UBU001
	12/10/48	74	F			MO	63139	RETIREE	UBU001
	7/3/55	68	F			MO	63119	RETIREE	UBU001
	7/21/43	80	F			MO	63051	RETIREE	UBU001
	1/16/45	78	M			MO	63124	RETIREE	UBU001
	10/8/42	81	F			MO	63125	RETIREE	UBU001
	8/2/50	73	F			MO	63129	RETIREE	UBU001
	12/9/48	74	F			MO	63126	RETIREE	UBU001
	6/3/58	65	F			IL	62203	RETIREE	UBU001
	2/19/46	77	F			MO	63103	RETIREE	UBU001
	12/18/37	85	F			MO	63119	RETIREE	UBU001
	2/20/39	84	M			MO	63034	RETIREE	UBU001
	5/6/61	62	M			MO	63116	RETIREE	UBU001
	12/23/42	80	F			MO	63303	RETIREE	UBU001
	5/25/63	60	M			MO	63028	RETIREE	UBU001
	12/4/45	77	F			MO	63366	RETIREE	UBU001
	4/8/46	77	F			NC	28443	RETIREE	UBU001
	9/17/39	84	F			MO	63104	RETIREE	UBU001
	1/27/58	65	F			MO	63139	RETIREE	UBU001
	12/3/44	78	F			MO	63119	RETIREE	UBU001
	10/25/45	78	F			MO	63112	RETIREE	UBU001
	6/2/32	91	F			MO	63103	RETIREE	UBU001
	5/20/45	78	M			AL	35802	RETIREE	UBU001
	12/24/50	72	F			IL	62226	RETIREE	UBU001
	9/24/45	78	F			MO	63121	RETIREE	UBU001
	9/14/43	80	F			MO	63137	RETIREE	UBU001
	4/18/38	85	F			VA	20124	RETIREE	UBU001
	1/31/47	76	F			MO	63130	RETIREE	UBU001
	8/5/46	77	F			IL	62239	RETIREE	UBU001
	2/2/48	75	F			TN	38261	RETIREE	UBU001
	4/25/61	62	F			MO	63146	RETIREE	UBU002
	5/17/63	60	F			MI	49127	RETIREE	UBU002
	8/4/58	65	F			IL	62269	RETIREE	UBU002
	9/19/64	59	F			MO	63112	RETIREE	UBU002
	10/11/62	61	F			CO	80217	RETIREE	UBU002
	1/2/62	61	F			MO	63130	RETIREE	UBU002
	9/11/57	66	F			MO	63033	RETIREE	UBU002
	8/3/62	61	F			MO	63123	RETIREE	UBU002
	11/25/61	62	F			MO	63123	RETIREE	UBU002
	4/2/64	59	F			MO	63109	RETIREE	UBU002
	11/10/72	51	F			MO	63033	RETIREE	UBU002
	8/13/62	61	F			MO	63121	RETIREE	UBU002
	9/15/49	74	F			IL	62236	RETIREE + SPOUSE	UBU003
	12/5/55	67
	6/12/57	66	M			MO	63130	RETIREE + FAM	UBU012
	11/16/05	18	F
	11/12/07	16	F
	12/15/09	13	M
	5/3/47	76	M			MO	63128	RETIREE	UBU015
	5/15/42	81	F			MO	63347	RETIREE	UBU015
	11/16/41	82	F			MI	49548	RETIREE	UBA001
	11/8/44	79	M			MO	63122	RETIREE	UBA001
	12/21/34	88	F			MA	02664	RETIREE	UBA001
	9/5/61	62	F			MO	63128	RETIREE	UBA002
	5/22/61	62	F			MO	63130	RETIREE	UBA002
	7/6/61	62	F			MO	63123	RETIREE	UBA002
	12/26/61	61	F			MO	63130	RETIREE	UBA005
	12/8/59	63	M			MO	63129	RETIREE	UBA002
	1/2/62	61
	4/1/26	97	F			MO	63116	RETIREE	UBA015
	5/24/63	60	F			MO	63025	RETIREE + FAMILY	UBA019
	9/30/91	32
	9/12/63	60
	2/5/35	88	F					RETIREE	UBU001
	8/25/61	62	F			IL	62281	RETIREE	UBU002
	11/29/65	58	F			MO	63031	RETIREE	UBU002
	6/18/63	60	M			MO	63105	RETIREE	UBU002
	11/20/61	62	F			MO	63017	RETIREE	UBU002
	11/28/61	62	F			MO	63116	RETIREE + FAMILY	UBU006
	4/2/61	62

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