| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ANSAY & ASSOCIATES LLC3 | 101 E GRAND AVE STE 11 PORT WASHINGTON, WI 530742241 | UNITEDHEALTHCARE INSURANCE COMPANY | $4K | $21K | $25K | 0.61% |
| ANSAY & ASSOCIATES LLC3 | 101 E GRAND AVE STE 11 PORT WASHINGTON, WI 53074 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $573 | — | $573 | 1.00% |
| ANSAY & ASSOCIATES LLC3 | 101 E GRAND AVE STE 11 PORT WASHINGTON, WI 53074 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 15.00% |
| ANSAY & ASSOCIATES LLC3 | 101 E GRAND AVE STE 11 PORT WASHINGTON, WI 53074 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 15.00% |
| PAYCOM PAYROLL LLC5 | 7501 W MEMORIAL RD OKLAHOMA CITY, OK 73142 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $8K | $8K | 141.96% |
| ANSAY & ASSOCIATES LLC3 | 101 E GRAND AVE STE 11 PORT WASHINGTON, WI 53074 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $793 | — | $793 | 15.01% |
| PAYCOM PAYROLL LLC5 | 7501 W MEMORIAL RD OKLAHOMA CITY, OK 73142 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $8K | $8K | 151.67% |
| ANSAY & ASSOCIATES LLC3 | 101 E GRAND AVE STE 11 PORT WASHINGTON, WI 53074 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $742 | — | $742 | 15.01% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTYADMINISTRATOR | Contract Administrator Service code 13 | — | $16K |
| ANSAY & ASSOCIATES BROKER | Insurance agents and brokers Service code 22 | 9809 S FRANKLIN DR STE 300 FRANKLIN, WI 53132 | $212 |
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 | 277 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 285 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 628 | $4.1M |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 561 | $157K |
| Long-term disability(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 561 | $107K |
| Other(5 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 561 | $176K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 628 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
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.