Landscape Forms, Inc.
Overview
Landscape Forms, Inc. sponsors a self-funded health plan that covered 510 participants in plan year 2025, up 5% from the prior year. The plan year starts in January. Alongside medical, its benefits filing reports life insurance, dental, short-term disability, prepaid legal, and more.
- Plan type
- ERISA welfare benefit plan, self-funded (benefits paid from employer assets or a trust)
- Participants
- 510 · prior year 484
- Plan year
- Begins January 1 · next renewal January 2027
- Health plans filed
- Landscape Forms Inc. Group Medical Insurance Plan, plan 512 (510 participants)
- Broker compensation
- $64K across insured contracts
Insurance carriers
Insured coverage reported on Schedule A. Self-funded medical claims aren't reported there.
| Carrier | Coverage | Covered | Premium | Broker comp |
|---|---|---|---|---|
| United of Omaha Life Insurance Company | Life, Long-term disability | 605 | $311K | $61K |
| Pre-Paid Legal Services Inc. DBA Legalshield | Legal Services Plan Memberships | 72 | $19K | $3K |
Pharmacy benefit estimate
StreamRX estimate for a plan this size. Not based on this plan's claims.
Estimated prescription spend: 510 participants × $2,371 national average per member. Usually higher once dependents are counted.
Typical savings opportunity found in independent reviews of plans this size.
Form 5500 filing details
- Filing
- Form 5500 with Schedule A, plan year 2025
- Plan sponsor
- Landscape Forms, Inc.
- Sponsor EIN
- 38-1897577
- Plan number
- 512
- Filed with
- U.S. Department of Labor (EBSA) via EFAST2
Verify this filing: search EIN 38-1897577 in the Department of Labor's EFAST2 Form 5500 search.
Retirement plan
- Plan
- Landscape Forms, Inc. Profit Sharing Plan
- Type
- 401(k) plan
- Participants
- 873
About this data
Source: Landscape Forms, Inc.'s Form 5500 filing for plan year 2025 and its Schedule A insurance reports, published by the U.S. Department of Labor. "Self-funded" means the filing reports benefits paid from employer assets or a trust, with no medical insurance contract or with a stop-loss contract. Pharmacy figures are StreamRX estimates based on national averages. StreamRX is not affiliated with Landscape Forms, Inc..