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 |
|---|---|---|---|
| BANKERS FIDELITY LIFE INSURANCE CO EIN 58-0658963 LIFE & ADD PREMIUMS | Insurance agents and brokers Service code 22 | — | $34K |
| HEALTHSMART BENEFIT SOLUTIONS EIN 75-1857307 THIRD PARTY ADMINISTRATOR | Plan Administrator Service code 14 | — | $22K |
| PHCS EIN 13-3068979 PPO NETWORK | Insurance services Service code 23 | — | $6K |
| INTEGRATED WORKSITE SOLUTIONS EIN 90-1005770 SERVICING AGENT | Insurance agents and brokers Service code 22 | — | $5K |
| AMERICAN INSURNET EIN 31-1383515 SERVICING AGENT | Insurance agents and brokers Service code 22 | — | $3K |
| CLIFFORD BELL EIN 57-8683794 SERVICING AGENT | Insurance agents and brokers Service code 22 | — | $3K |
| TONY FLITTNER EIN 30-4723864 SERVICING AGENT | Insurance agents and brokers Service code 22 | — | $2K |
| HEALTHSMART CARE MANAGEMENT EIN 75-2960859 UTILIZATION REVIEW VENDOR | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $2K |
| TELADOC EIN 04-3705970 MEDICAL CONSULTANT | Consulting fees Service code 70 | — | $1K |
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 | 216 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 216 | 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.