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 |
|---|---|---|---|
| ANTHEM BLUE CROSS AND BLUE SHIELD | Contract Administrator; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | 3075 VANDERCAR WAY 262-212-7597 CINCINNATI, OH 45209 | $865K |
| FOX ROTHSCHILD, LLP EIN 23-1404723 | Legal Service code 29 | — | $207K |
| JAMA BARBOUR EIN 42-0930021 | Plan Administrator Service code 14 | — | $105K |
| JAMIE KOOYMAN EIN 42-0930021 | Employee (plan) Service code 30 | — | $103K |
| ZACH HESTER EIN 42-0930021 | Employee (plan) Service code 30 | — | $90K |
| BASYS, INC. EIN 52-1796473 | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $73K |
| INCOME RESEARCH & MANAGEMENT EIN 04-2955404 | Investment management Service code 28 | — | $60K |
| THE SEGAL COMPANY EIN 13-1975125 | Consulting (general); Actuarial Service code 11 | — | $55K |
| JORDYN COX EIN 42-0930021 | Employee (plan) Service code 30 | — | $54K |
| PAUL LAMUNYON EIN 42-0930021 | Employee (plan) Service code 30 | — | $45K |
| DAWN NELSON EIN 42-0930021 | Employee (plan) Service code 30 | — | $45K |
| DEBOER & ASSOCIATES, PC EIN 47-0836395 | Accounting (including auditing) Service code 10 | — | $39K |
| ASSET CONSULTING GROUP EIN 43-1512694 | Investment advisory (plan) Service code 27 | — | $24K |
| NINETY ONE INTERNATIONAL DYNAMIC EIN 41-2282919 | Investment management Service code 28 | — | $21K |
| IOWA STATE BANK EIN 42-0335294 | Custodial (securities) Service code 19 | — | $19K |
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 | 1,441 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 296 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,737 | 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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.