| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HJ KNIGHT INTERNATIONAL3 | 30 BRAINTREE HILL OFFICE PARK SUITE 203 BRAINTREE, MA 02184 | HCC LIFE INSURANCE COMPANY | — | $23K | $23K | 5.05% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF WISCONSIN EIN 39-0138065 NONE | Float revenue; Contract Administrator; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other services Service code 12 | — | $290K |
| WILSON-MCSHANE CORPORATION EIN 41-0956552 NONE | Plan Administrator Service code 14 | — | $272K |
| REINHART, BOERNER & VAN DEUREN EIN 39-1126909 NONE | Legal Service code 29 | — | $71K |
| LEE JOST AND ASSOCIATES EIN 39-1400101 NONE | Actuarial; Consulting (general) Service code 11 | — | $43K |
| OPTUM EIN 11-2581812 NONE | Contract Administrator Service code 13 | — | $35K |
| JB INVESTMENT MANAGEMENT, LLC EIN 61-1550321 NONE | Investment management Service code 28 | — | $28K |
| ANDCO CONSULTING, LLC EIN 59-3676225 NONE | Investment management Service code 28 | — | $28K |
| CASE MANAGEMENT SPECIALISTS EIN 61-1688248 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $20K |
| BAUMAN ASSOCIATES, LTD. EIN 39-1277627 NONE | Accounting (including auditing) Service code 10 | — | $19K |
| ASSOCIATED TRUST COMPANY EIN 39-1564826 NONE | Custodial (securities) Service code 19 | — | $9K |
| DELTA DENTAL EIN 39-6094742 NONE | Contract Administrator Service code 13 | — | $9K |
| COMBINED CRAFTS EIN 39-1400101 NONE | Accounting (including auditing) Service code 10 | — | $6K |
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 | 695 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 141 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 836 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 796 | $47K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 701 | $462K |
| Other | ANTHEM LIFE INSURANCE COMPANY | 796 | $47K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 796 | — |
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.