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 |
|---|---|---|---|
| ADMINISTRATIVE CONSULTING SERVICES EIN 62-1408699 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $196K |
| HORIZON ACTUARIAL SERVICES, INC. EIN 26-1370698 NONE | Direct payment from the plan; Consulting (general) Service code 16 | — | $132K |
| REINHART, ET AL EIN 39-1126909 NONE | Legal; Direct payment from the plan Service code 29 | — | $128K |
| DENNIS G. JENKINS, C.P.A., LLC EIN 20-5886120 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $126K |
| BLUE CROSS BLUE SHIELD OF ILLINOIS EIN 36-1236610 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $90K |
| UFCW BENEFITS ADMINISTRATION, LLC EIN 77-0613772 NONE | Plan Administrator; Direct payment from the plan Service code 14 | — | $64K |
| DELTA DENTAL EIN 94-2761537 NONE | Direct payment from the plan; Claims processing Service code 12 | — | $56K |
| PRINCIPAL FINANCIAL GROUP INC EIN 42-1520346 NONE | Direct payment from the plan; Custodial (securities); Investment management Service code 19 | — | $36K |
| PATRICK FLYNN ATTORNEY AT LAW EIN 75-1379068 NONE | Legal; Direct payment from the plan Service code 29 | — | $33K |
| NOVAK FRANCELLA, LLC EIN 61-1436956 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $29K |
| WELLS FARGO BANK EIN 94-1347393 NONE | Other services; Direct payment from the plan Service code 49 | — | $15K |
| OPTUM RX EIN 75-1379068 NONE | Claims processing; Direct payment from the plan Service code 12 | — | $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 | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 0 | 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.