15 years ago I worked for a "non-profit" health insurance company that was a Blue Cross Blue Shield affiliate/franchise. The CEO made $2.1m/year while the other VPs were raking in > $1m. The IT organization was as backward as they come - 200+ full time employees. I got in trouble for trying to introduce using source control to their developers. Beyond that, they used Excel spreadsheets as the source of truth for their healthcare plans...and the spreadsheets fed the claims processing system. There were 20 dedicated employees to managing Excel spreadsheets.