| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC Filed as: WILLIS TOWERS WATSON MIDWEST INC | 400 N EXECUTIVE DRIVE STE 30 BROOKFIELD, WI 53005 | BLUE CROSS BLUE SHIELD OF WISCONSIN | $20K | — | $20K | 1.56% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN INC | 400 N EXECUTIVE DRIVE STE 300 BROOKFIELD, WI 53005 | BLUE CROSS BLUE SHIELD OF WISCONSIN | $13K | $546 | $14K | 1.05% |
| GREEN BAY INSURANCE CENTER INC3 | 417 S MONROE AVENUE GREEN BAY, WI 54301 | BLUE CROSS BLUE SHIELD OF WISCONSIN | $10K | — | $10K | 0.75% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE SERV | 801 SOUTH FIGUEROA ST STE 800 LOS ANGELES, CA 90017 | BLUE CROSS BLUE SHIELD OF WISCONSIN | — | $2K | $2K | 0.13% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST INC | 400 N EXECUTIVE DRIVE STE 30 BROOKFIELD, WI 53005 | COMPCARE HEALTH SERVICES INSURANCE CORPORATION | $8K | — | $8K | 1.45% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN INC | 400 N EXECUTIVE DRIVE STE 300 BROOKFIELD, WI 53005 | COMPCARE HEALTH SERVICES INSURANCE CORPORATION | $5K | $224 | $6K | 0.98% |
| GREEN BAY INSURANCE CENTER INC3 | 417 S MONROE AVENUE GREEN BAY, WI 54301 | COMPCARE HEALTH SERVICES INSURANCE CORPORATION | $4K | — | $4K | 0.70% |
| WILLIS TOWERS WATSON US LLC Filed as: WILLIS TOWERS WATSON INSURANCE SERV | 801 SOUTH FIGUEROA ST STE 800 LOS ANGELES, CA 90017 | COMPCARE HEALTH SERVICES INSURANCE CORPORATION | — | $671 | $671 | 0.12% |
| WILLIS TOWERS WATSON US LLC Filed as: WILLIS TOWERS WATSON MIDWEST INC | 400 N EXECUTIVE DRIVE STE 30 BROOKFIELD, WI 53005 | ANTHEM LIFE INSURANCE COMPANY | $13K | — | $13K | 7.46% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF WISCONSIN INC | 400 N EXECUTIVE DRIVE STE 300 BROOKFIELD, WI 53005 | ANTHEM LIFE INSURANCE COMPANY | $8K | $332 | $8K | 5.01% |
| GREEN BAY INSURANCE CENTER INC | 417 S MONROE AVENUE GREEN BAY, WI 54301 | ANTHEM LIFE INSURANCE COMPANY | $5K | — | $5K | 3.23% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE SERV | 801 SOUTH FIGUEROA ST STE 800 LOS ANGELES, CA 90017 | ANTHEM LIFE INSURANCE COMPANY | — | $996 | $996 | 0.59% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BOON ADMINISTRATIVE SERVICES EIN 33-0449333 CONTRACTED THIRD PARTY AD | Contract Administrator; Claims processing; Direct payment from the plan Service code 12 | 6300 BRIDGE POINT PKWY SUITE 3-500 AUSTIN, TX 78730 | $15K |
| THE BOON INSURANCE AGENCY EIN 74-2236168 MARKTING AGENT | Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | 6300 BRIDGE POINT PKWY SUITE 3-200 AUSTIN, TX 78730 | $7K |
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 | 231 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 231 | 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 | 133 | $1.9M |
| Dental | BLUE CROSS BLUE SHIELD OF WISCONSIN | 133 | $1.3M |
| Vision | BLUE CROSS BLUE SHIELD OF WISCONSIN | 133 | $1.3M |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 230 | $168K |
| Short-term disability | ANTHEM LIFE INSURANCE COMPANY | 230 | $168K |
| Long-term disability | ANTHEM LIFE INSURANCE COMPANY | 230 | $168K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 230 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.