| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JL HUBBARD INSURANCE3 Filed as: J L HUBBARD INS. & BONDS AGENCY INC | PO BOX 14 1090 SOUTH ROUTE 51 FORSYTH, IL 62535 | BLUECROSS BLUESHIELD OF ILLINOIS | $29K | $1 | $29K | 3.15% |
| FIRST MID INSURANCE GROUP INC3 Filed as: FIRST MID INSURANCE GROUP, INC. | UNKNOWN DECATUR, IL 62526 | BLUECROSS BLUESHIELD OF ILLINOIS | $8K | $1K | $9K | 1.00% |
| FIRST MID INSURANCE GROUP INC3 Filed as: FIRST MID INSURANCE GROUP, INC. | 1520 CHARLESTON AVENUE MATTOON, IL 61938 | DEARBORN LIFE INSURANCE COMPANY | $6K | $0 | $6K | 13.65% |
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 | 250 | 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) | 250 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUESHIELD OF ILLINOIS | 103 | $921K |
| Dental | DELTA DENTAL OF ILLINOIS | 139 | $34K |
| Vision | PROTEC INSURANCE COMPANY | 108 | $9K |
| Life insurance | DEARBORN LIFE INSURANCE COMPANY | 152 | $44K |
| Long-term disability | DEARBORN LIFE INSURANCE COMPANY | 152 | $44K |
| Prescription drug | BLUECROSS BLUESHIELD OF ILLINOIS | 103 | $921K |
| Other(2 contracts, 2 carriers) | DEARBORN LIFE INSURANCE COMPANY | 250 | $48K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 250 | — |
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.