Form 5500 · Employee benefit plan · ELMHURST, MA
WINDY CITY REPRESENTATIVES
The filing calls this plan WINDY CITY REPRESENTATIVES HEALTH AND WELFARE PLAN.
WINDY CITY REPRESENTATIVES of ELMHURST, MA insures health, dental, vision, life and disability coverage for its employees, per Schedule A of its Form 5500. Its broker of record is HUB INTERNATIONAL MIDWEST LIMITED. Coverage is written through BLUECROSS BLUESHIELD OF ILLINOIS and 2 other carriers. The plan's most recent policy period ended in November.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 36-4656891 · plan 501 · plan year 2025, filed Jun 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.
Benefits declared on this filing
Also declared: death benefits, other welfare.
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 3 insured contracts covering health, dental, vision, life and disability; the largest, with BLUECROSS BLUESHIELD OF ILLINOIS, covers 220 people.
Reported premium across the insured contracts is $1,978,002, with $89,139 in disclosed broker commissions — about 4.5% of premium.
The most recent policy period ended in November, and the plan year ends November 30. Group contracts typically renew on that annual cycle.
HUB INTERNATIONAL MIDWEST LIMITED is the broker of record on all 3 contracts.
3 carriers appear on the filing, including BLUECROSS BLUESHIELD OF ILLINOIS, DEARBORN LIFE INSURANCE COMPANY and AFLAC. BLUECROSS BLUESHIELD OF ILLINOIS writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUECROSS BLUESHIELD OF ILLINOIS | Health, Dental | 220 | Dec 1, 2025 | $1,819,109 | $73,494 |
| DEARBORN LIFE INSURANCE COMPANY | Vision, Life, Disability | 161 | Dec 1, 2025 | $158,083 | $15,557 |
| AFLAC | Health, Life | 2 | Dec 1, 2025 | $810 | $88 |
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.
Other plans filed by this employer
How this plan compares
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