| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN INC | 400 N EXECUTIVE DRIVE STE 400 BROOKFIELD, WI 53005 | BLUE CROSS BLUE SHIELD OF WISCONSIN | $39K | — | $39K | 3.16% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST INC | 330 W COLLEGE AVE SUITE 201 APPLETON, WI 54911 | BLUE CROSS BLUE SHIELD OF WISCONSIN | — | $5K | $5K | 0.42% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN INC | 400 N EXECUTIVE DRIVE STE 400 BROOKFIELD, WI 53005 | COMPCARE HEALTH SERVICES INSURANCE CORPORATION | $6K | — | $6K | 3.09% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST INC | 330 W COLLEGE AVE SUITE 201 APPLETON, WI 54911 | COMPCARE HEALTH SERVICES INSURANCE CORPORATION | — | $793 | $793 | 0.41% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN INC. | 400 N EXECUTIVE DRIVE STE 400 BROOKFIELD, WI 53005 | ANTHEM LIFE INSURANCE COMPANY | $19K | — | $19K | 13.64% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST INC | 330 W COLLEGE AVE SUITE 201 APPLETON, WI 54911 | ANTHEM LIFE INSURANCE COMPANY | — | $2K | $2K | 1.80% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BOON ADMINISTATIVE SERVICES EIN 33-0449333 CONTRACTED THIRD PARTY AD | Direct payment from the plan; Claims processing; Contract Administrator Service code 12 | 6300 BRIDGE POINT PKWY SUITE 3-500 AUSTIN, TX 78730 | $16K |
| THE BOON INSURANCE AGENCY EIN 74-2236168 MARKETING AGENT | Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | 6300 BRIDGE POINT PKWY SUITE 3-200 AUSTIN, TX 78730 | $11K |
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 | 236 | Currently employed and enrolled or eligible. |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 238 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF WISCONSIN | 143 | $1.4M |
| Dental | BLUE CROSS BLUE SHIELD OF WISCONSIN | 143 | $1.2M |
| Vision | BLUE CROSS BLUE SHIELD OF WISCONSIN | 143 | $1.2M |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 236 | $136K |
| Short-term disability | ANTHEM LIFE INSURANCE COMPANY | 236 | $136K |
| Long-term disability | ANTHEM LIFE INSURANCE COMPANY | 236 | $136K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 236 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.