Form 5500 · Employee benefit plan · MILAN, IL
BLACKHAWK BANK & TRUST
Public Form 5500 records show how BLACKHAWK BANK & TRUST of MILAN, IL, a finance and insurance employer, structures its employee benefits. Its broker of record is LB BENEFITS INC. Coverage is written through BLUE CROSS BLUE SHIELD and 3 other carriers. The plan's most recent policy period ended in June.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 36-2463577 · plan 502 · plan year 2025, filed Jan 28, 2026
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
A stop-loss policy appears on a Form 5500 only when the plan itself is the beneficiary, or the premiums are paid from plan money. Many employers buy stop-loss and never report it here. So a plan with no stop-loss on its filing may still have it.
Benefits declared on this filing
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 5 insured contracts covering health, dental, vision, life, disability and stop-loss; the largest, with BLUE CROSS BLUE SHIELD, covers 245 people.
The filing lists a stop-loss contract. On its own that does not settle whether the plan pays its own claims.
Reported premium across the insured contracts is $1,992,092, with $34,839 in disclosed broker commissions — about 1.7% of premium.
The health contract's policy period ended in June, while at least one ancillary line's policy period ended in September. The plan is on a split renewal cycle.
LB BENEFITS INC is the broker of record on 4 of the 5 contracts; the rest name a different broker or none.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUE CROSS BLUE SHIELD | Health, Stop-loss | 245 | Jul 1, 2025 | $1,786,855 | $11,232 |
| DEARBORN LIFE INSURANCE COMPANY | Life, Disability | 213 | Jul 1, 2025 | $60,828 | $8,920 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life | 212 | Sep 2, 2025 | $56,618 | $8,493 |
| BLUE CROSS BLUE SHIELD | Dental | 195 | Jul 1, 2025 | $77,871 | $5,448 |
| VSP | Vision | 108 | Jul 1, 2025 | $9,920 | $746 |
Premium and claims on this contract
BLUE CROSS BLUE SHIELD, contract 344383. For the contract year on this filing, the carrier reported $1,786,855 in premium earned and $1,818,359 in claims incurred. Dividing one by the other gives 102%.
- BLUE CROSS BLUE SHIELD, contract 344383 reported $-31,504 in retention.
Retention is what the carrier kept of the premium after claims, as reported: administration, commissions and other charges.
Only experience-rated contracts report these figures, so most filings leave them blank.
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. The service providers are named on Schedule C of this filing. We publish company names only.
Other plans filed by this employer
How this plan compares
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