| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FOSTER THOMAS INC3 Filed as: FOSTER FINANCIAL SERVICES INC | — | BLUECROSS BLUESHIELD OF ILLINOIS | $30K | — | $30K | 2.09% |
| FIRST MID INSURANCE GROUP INC3 | — | BLUECROSS BLUESHIELD OF ILLINOIS | $29K | — | $29K | 1.99% |
| SHANNON, DOUGLAS3 | 401 SW WATER ST STE 303 PEORIA, IA 61602 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 8.22% |
| FIRST MID INSURANCE GROUP INC3 | 1520 CHARLESTON AVE. MATTOON, IL 61938 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 5.97% |
| VARIOUS - SEE ATTACHED3 Filed as: AFLAC BENEFITS ADVISORS INC. | 1932 WYNNTON RD COLUMBUS, GA 31999 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $834 | — | $834 | 5.90% |
| JL HUBBARD INSURANCE3 Filed as: J L HUBBARD INSURANCE & BONDS AGCY | PO BOX 14 FORSYTH, IL 62535 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $579 | — | $579 | 4.10% |
No Schedule C service providers reported on this filing.
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 | 107 | 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) | 107 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 222 | $1.5M |
| Dental | BLUECROSS BLUESHIELD OF ILLINOIS | 222 | $1.5M |
| Vision | RELIANCE STANDARD LIFE INSURANCE COMPANY | 116 | $14K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 105 | $54K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 105 | $54K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 105 | $54K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 105 | $54K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 222 | — |
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.