| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ANSAY & ASSOCIATES LLC3 | 101 E GRAND AVE STE 11 PORT WASHINGTON, WI 53074 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $234 | $5K | 14.69% |
| ANSAY & ASSOCIATES LLC3 | 101 E GRAND AVE STE 11 PORT WASHINGTON, WI 53074 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $205 | $4K | 11.58% |
| ANSAY & ASSOCIATES LLC3 | 101 E GRAND AVE STE 11 PORT WASHINGTON, WI 53074 | WYSSTA INSURANCE COMPANY INC | $2K | — | $2K | 8.40% |
| ANSAY & ASSOCIATES LLC3 | 101 E GRAND AVE STE 11 PORT WASHINGTON, WI 53074 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $143 | $2K | 10.61% |
| ANSAY & ASSOCIATES LLC3 | 101 E GRAND AVE STE 11 PORT WASHINGTON, WI 53074 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $136 | $3K | 15.64% |
| ANSAY & ASSOCIATES LLC3 | 101 E GRAND AVE STE 11 PORT WASHINGTON, WI 53074 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $123 | $3K | 15.58% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTYADMINISTRATOR | Contract Administrator Service code 13 | — | $17K |
| ANSAY & ASSOCIATES LLC BROKER | Insurance agents and brokers Service code 22 | 101 E GRAND AVE STE 11 PORT WASHINGTON, WI 53074 | $1K |
| ANSAY & ASSOCIATES BROKER | Insurance agents and brokers Service code 22 | 9809 S FRANKLIN DR STE 300 FRANKLIN, WI 53132 | $155 |
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 | 362 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 10 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 377 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | WYSSTA INSURANCE COMPANY INC | 265 | $28K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 359 | $23K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 360 | $34K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 245 | $799K |
| Other(5 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 359 | $136K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 360 | — |
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.