| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FMLASOURCE INC5 Filed as: FMLASOURCE INC. | 455 N CITYFRONT PLAZA DRIVE-13TH FL CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $8K | $8K | 39.31% |
| ANSAY & ASSOCIATES LLC3 Filed as: ANSAY & ASSOCIATES, LLC | 101 E. GRAND AVE - SUITE 11 PORT WASHINGTON, WI 53074 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $666 | $4K | 18.48% |
| ANSAY & ASSOCIATES LLC3 Filed as: ANSAY & ASSOCIATES, LLC | 101 E GRAND AVE.-STE 11 PORT WASHINGTON, WI 53074 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $574 | $3K | 18.37% |
| ANSAY & ASSOCIATES LLC3 Filed as: ANSAY & ASSOCIATES, LLC | 101 E. GRAND AVE. - STE 11 PORT WASHINGTON, WI 53074 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $567 | $2K | 13.72% |
| ANSAY & ASSOCIATES LLC3 Filed as: ANSAY & ASSOCIATES, LLC | 101 E GRAND AVE-STE 11 PORT WASHINGTON, WI 53074 | WYSSTA INSURANCE COMPANY, INC. | $859 | — | $859 | 8.00% |
| ANSAY & ASSOCIATES LLC3 Filed as: ANSAY & ASSOCIATION, LLC | 101 E GRAND AVE - SUITE 11 PORT WASHINGTON, WI 53074 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $874 | $312 | $1K | 13.58% |
| ANSAY & ASSOCIATES LLC3 Filed as: ANSAY & ASSOCIATES, LLC | 101 E GRAND AVE-STE. 11 PORT WASHINGTON, WI 53074 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $264 | $1K | 18.24% |
| ANSAY & ASSOCIATES LLC3 Filed as: ANSAY & ASSOCIATES, LLC | 101 E. GRAND AVE - SUITE 11 PORT WASHINGTON, WI 53074 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $638 | $137 | $775 | 18.23% |
No Schedule C service providers reported on this filing.
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 | 134 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 135 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF WISCONSIN | 86 | $917K |
| Vision | WYSSTA INSURANCE COMPANY, INC. | 94 | $11K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 62 | $19K |
| Short-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 52 | $24K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 31 | $16K |
| Other(3 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 62 | $32K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 94 | — |
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.