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 |
|---|---|---|---|
| WILSON-MCSHANE CORPORATION EIN 41-0956552 NONE | Contract Administrator; Claims processing Service code 12 | — | $257K |
| BLUE CROSS BLUE SHIELD OF MN EIN 41-0984460 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Other fees; Claims processing; Contract Administrator Service code 12 | — | $160K |
| KUTAK ROCK LLP EIN 47-0597598 NONE | Legal Service code 29 | — | $83K |
| UNITED ACTUARIAL SERVICES EIN 35-2156428 NONE | Actuarial Service code 11 | — | $51K |
| PRIME THERAPEUTICS EIN 26-0076803 NONE | Other fees; Other services; Float revenue; Claims processing Service code 12 | — | $46K |
| TEAM LLC EIN 83-0469948 NONE | Other services Service code 49 | — | $22K |
| LEGACY PROFESSIONALS LLP EIN 32-0043599 NONE | Accounting (including auditing) Service code 10 | — | $19K |
| UNION BANK & TRUST EIN 41-1267434 NONE | Custodial (securities) Service code 19 | — | $14K |
| WELLS FARGO ADVISORS LLC EIN 34-1542819 NONE | Investment advisory (plan) Service code 27 | — | $10K |
| RBC WEALTH MANAGEMENT EIN 41-1416330 NONE | Investment advisory (plan) Service code 27 | — | $10K |
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 | 706 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 209 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 49 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 964 | 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.