Plan Ledger DOL Form 5500 · updated monthly

First State Bank of Middleburybenefits

First State Bank of Middlebury Welfare Benefit Plan · MIDDLEBURY, IN · plan year 2025

Broker compensation reported · 2025
$21,245

First State Bank of Middlebury's benefits plans covered 104 active participants in 2025, providing life · dental · vision · short-term disability · long-term disability · death benefits. Insurance premiums totaled $48,224. Insurance brokers and agents were paid $21,245 in commissions and fees, costs that ultimately come out of what the employer and employees pay for coverage. That works out to 44.1% of premiums. That is $204 per covered person, above the median for employer plans that report broker pay. Broker pay rose 0.7% from $21,097 in 2024.

Insurance contracts · 20252
DELTA DENTAL OF INDIANA · dental$48K · 135 covered
UNITED OF OMAHA LIFE INSURANCE COMPANY · vision life std ltdpremiums n/a · 104 covered
Brokers & agents paid · 20253
GIBSON INSURANCE AGENCY, INC.$13,448 · incl $3,969 fees
GIBSON INSURANCE AGENCY$4,450
JAMES R NELLIGAN AND ASSOC$3,347 · incl $3,347 fees
Also brokered by Gibson Insurance Agency, Inc.5
Forest River, Inc. IN$1,183,448
Boyd Corporation CA$199,476

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Source: DOL Form 5500 Schedule A, plan year 2025, EIN 350310540 · Verify on EFAST2 · Amounts are as reported by the plan sponsor.