| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| GREEN BAY INSURANCE CENTER INC3 | 417 S MONROE AVE GREEN BAY, WI 54301 | UNITED HEALTHCARE INSURANCE COMPANY | $8K | $56K | $64K | 2.86% |
| GREEN BAY INSURANCE CENTER INC3 | 417 S MONROE AVE GREEN BAY, WI 54301 | ANTHEM LIFE INSURANCE COMPNAY | $6K | $0 | $6K | 10.78% |
| GREEN BAY INSURANCE CENTER INC3 | 417 S MONROE AVE GREEN BAY, WI 54301 | ANTHEM LIFE INSURANCE COMPANY | $6K | — | $6K | 17.10% |
| GREEN BAY INSURANCE CENTER INC3 | 417 S MONROE AVE GREEN BAY, WI 54301 | ANTHEM LIFE INSURANCE COMPANY | $6K | — | $6K | 17.22% |
| GREEN BAY INSURANCE CENTER INC3 | 417 S MONROE AVE GREEN BAY, WI 54301 | ANTHEM LIFE INSURANCE COMPANY | $4K | $0 | $4K | 16.32% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BOON ADMINISTRATIVE SERVICES EIN 33-0449333 CONTRACTED THIRD PARTY AD | Claims processing; Direct payment from the plan; Contract Administrator Service code 12 | 6300 BRIDGE POINT PKWY SUIYTE 3-500 AUSTIN, TX 78730 | $11K |
| 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 | $3K |
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 | 265 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 265 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED HEALTHCARE INSURANCE COMPANY | 265 | $2.2M |
| Life insurance(2 contracts, 2 carriers) | ANTHEM LIFE INSURANCE COMPNAY | 227 | $74K |
| Short-term disability(2 contracts, 2 carriers) | ANTHEM LIFE INSURANCE COMPNAY | 219 | $90K |
| Long-term disability(2 contracts, 2 carriers) | ANTHEM LIFE INSURANCE COMPNAY | 219 | $90K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 265 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.