| 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 | $56K | — | $56K | 4.04% |
| HOELTING, WILLIAM M3 | 1301 RED OAK LN ROCKFORD, IL 61107 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $6K | — | $6K | 10.75% |
| MFG LLC3 | 4453 N MULFORD RD LOVES PARK, IL 61111 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $427 | $427 | 0.82% |
| HOELTING, WILLIAM M3 | 1301 RED OAK LN ROCKFORD, IL 61107 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 16.23% |
| MFG LLC3 | 4453 N MULFORD RD LOVES PARK, IL 61111 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $146 | $146 | 0.81% |
| MFG LLC3 | 4453 N MULFORD RD LOVES PARK, IL 611116957 | HUMANA INSURANCE COMPANY | $2K | — | $2K | 9.89% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPLOYEE BENEFITS CORPORATION EIN 39-2044064 CLAIMS PROCESSING | Contract Administrator; Claims processing Service code 12 | — | $6K |
| JODI FRENCH-CHESMORE BROKER | Insurance agents and brokers Service code 22 | 4453 N MULFORD RD LOVES PARK, IL 61111 | $308 |
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 | 152 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 156 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 270 | $1.4M |
| Dental | BLUECROSS BLUESHIELD OF ILLINOIS | 270 | $1.4M |
| Vision | HUMANA INSURANCE COMPANY | 105 | $17K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 152 | $70K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 152 | $52K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 152 | $52K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 152 | $70K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 270 | — |
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.