| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STEVEN KOLLING3 | 888 HWY 153 MOSINEE, WI 54455 | WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION | $11K | — | $11K | 0.79% |
| JEFFREY LECLAIRE3 | 701 SAND LAKE RD ONALASKA, WI 54650 | WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION | $3K | — | $3K | 0.23% |
| ANSAY & ASSOCIATES LLC3 | PO BOX 427 EAGLE RIVER, WI 54521 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 7.83% |
| TIC INC3 Filed as: TIC INC. | 701 SAND LAKE RD ONALASKA, WI 54650 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $368 | — | $368 | 2.31% |
| ANSAY & ASSOCIATES LLC3 | PO BOX 427 EAGLE RIVER, WI 54521 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $162 | — | $162 | 8.07% |
| TIC INC3 Filed as: TIC INC. | 701 SAND LAKE RD ONALASKA, WI 54650 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $79 | — | $79 | 3.94% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 TPA | Contract Administrator Service code 13 | — | $3K |
| WILLIS OF WISCONSIN INC. INSURANCE AGENT | Custodial (securities) Service code 19 | 400 N EXECUITVE DR SUITE 300 BROOKFIELD, WI 53005 | $368 |
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 | 246 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 250 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION | 254 | $1.4M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 226 | $16K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 226 | $2K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 254 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.