| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JL HUBBARD INSURANCE3 Filed as: JL HUBBARD INSURANCE & BONDS AGENCY | — | BLUECROSS BLUE SHIELD OF ILLINOIS | $68K | $1K | $70K | 4.03% |
| JL HUBBARD INSURANCE3 Filed as: JL HUBBARD INS & BONDS AGENCY INC | 1090 S ROUTE 51 FORSYTH, IL 62535 | DEARBORN LIFE INSURANCE COMPANY | $5K | — | $5K | 14.69% |
| FIRST MID INSURANCE GROUP INC3 | 1520 CHARLESTON AVENUE MATTOON, IL 61938 | DEARBORN LIFE INSURANCE COMPANY | — | $1K | $1K | 4.54% |
| FIRST MID INSURANCE GROUP INC3 Filed as: FIRST MID INSURANCE GROUP | 1090 S ROUTE 51 FORSYTH, IL 62535 | EYE MED | $1K | — | $1K | 157.40% |
| USI INSURANCE SERVICES LLC3 | PO BOX 62889 VIRGINIA BEACH, VA 23466 | EYE MED | $56 | — | $56 | 6.28% |
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 | 101 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 105 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUECROSS BLUE SHIELD OF ILLINOIS | 284 | $1.7M |
| Dental | BLUECROSS BLUE SHIELD OF ILLINOIS | 284 | $1.7M |
| Vision(6 contracts) | EYE MED | 171 | $13K |
| Life insurance | DEARBORN LIFE INSURANCE COMPANY | 112 | $32K |
| Other | DEARBORN LIFE INSURANCE COMPANY | 112 | $32K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 284 | — |
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.