| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MFG LLC3 | 4453 N MULFORD ROAD PO BOX 15777 ROCKFORD, IL 611325777 | BLUECROSS BLUESHIELD OF ILLINOIS | $37K | — | $37K | 4.28% |
| MFG LLC3 | 4453 N MULFORD RD LOVES PARK, IL 61111 | HUMANA INSURANCE COMPANY | $3K | — | $3K | 4.30% |
| HOELTING, WILLIAM M3 | 1301 RED OAK LN ROCKFORD, IL 61107 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 11.17% |
| MFG LLC3 | 4453 N MULFORD RD LOVES PARK, IL 61111 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $243 | $243 | 0.75% |
| MFG LLC3 | 4453 N MULFORD RD LOVES PARK, IL 61111 | COMPBENEFITS INSURANCE COMPANY | $1K | — | $1K | 9.97% |
| HOELTING, WILLIAM M3 | 1301 RED OAK LN ROCKFORD, IL 61107 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 15.00% |
| MFG LLC3 | 4453 N MULFORD RD LOVES PARK, IL 61111 | UNUM LIFE INSURANCE COMPANY OF AMERICA | — | $56 | $56 | 0.74% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPLOYEE BENEFITS CORPORATION EIN 39-2044064 CLAIMS PROCESSING | Contract Administrator; Claims processing Service code 12 | — | $5K |
| MASS MUTUAL FINANCIAL GROUP BROKER | Insurance agents and brokers Service code 22 | WILLIAM HOELTING 4453 N MULFORD RD LOVES PARK, IL 61111 | $238 |
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 | 117 | 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) | 117 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 201 | $859K |
| Dental | HUMANA INSURANCE COMPANY | 95 | $71K |
| Vision | COMPBENEFITS INSURANCE COMPANY | 79 | $11K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 104 | $40K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 104 | $32K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 104 | $32K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 104 | $40K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 201 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.