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 |
|---|---|---|---|
| THE SEGAL COMPANY EIN 13-1835864 NONE | Insurance brokerage commissions and fees; Actuarial; Consulting (general); Direct payment from the plan Service code 11 | — | $52K |
| BDO USA P.C. EIN 13-5381590 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $50K |
| DISCIPLINED BENEFIT SERVICES, INC. EIN 84-1215883 NONE | Plan Administrator; Direct payment from the plan Service code 14 | — | $41K |
| THE SEGAL ADVISORS, INC EIN 13-2646110 NONE | Direct payment from the plan; Investment management Service code 28 | — | $41K |
| MARVIN SANDRIN TRUSTEE | Investment management; Direct payment from the plan Service code 28 | 2803 PINE RIDGE BLVD RED WING, MN 53066 | $30K |
| ARLO BERTSCH TRUSTEE | Direct payment from the plan; Investment management Service code 28 | 1400 K AVENUE EUREKA, SD 57437 | $25K |
| BILL CAMERON TRUSTEE | Investment management; Direct payment from the plan Service code 28 | 1904 DREW AVENUE S. MINNEAPOLIS, MN 55416 | $25K |
| EILEEN HALVERSON TRUSTEE | Investment management; Direct payment from the plan Service code 28 | 16226 CRYSTAL DRIVE EAST ENUMCLAW, WA 98022 | $25K |
| JOHN PAULY TRUSTEE | Direct payment from the plan; Investment management Service code 28 | 9900 PILLBURY AVENUE BLOOMINGTON, MN 55420 | $25K |
| STUART WOHL TRUSTEE | Investment management; Direct payment from the plan Service code 28 | 7929 LIBERTY WAY PARKLAND, FL 33067 | $25K |
| JENNER & BLOCK LLP NONE | Legal; Direct payment from the plan Service code 29 | 919 3RD AVE NEW YORK, NY 10022 | $17K |
| STATE STREET GLOBAL ADVISORS EIN 04-1867445 TRUSTEE | Direct payment from the plan; Investment management Service code 28 | — | $8K |
| GARY BERG TRUSTEE | Investment management; Direct payment from the plan Service code 28 | 2520 BANTAS POINT ROAD WAYZATA, MN 55391 | $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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 274 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 274 | 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."
Self-funded plan with no stop-loss carrier attached. Catastrophic-risk exposure; stop-loss specialist sales target.