| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ANSAY & ASSOCIATES LLC3 | 888 STATE HWY 153 SUITE 200 MOSINEE, WI 54455 | HARTFORD LIFE AND ACCIDENT | $14K | — | $14K | 10.61% |
| ANSAY & ASSOCIATES LLC3 | 2901 W BELTLINE HIGHWAY SUITE 202 MADISON, WI 53713 | HARTFORD LIFE AND ACCIDENT | — | $391 | $391 | 0.30% |
| ANSAY & ASSOCIATES LLC3 | 101 E GRAND AVE SUITE 11 PORT WASHINGTON, WI 53074 | WYSSTA INSURANCE COMPANY INC | $2K | — | $2K | 8.10% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $30K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMIN | Contract Administrator Service code 13 | — | $8K |
| EMPLOYEE BENEFITS CORPORATION EIN 39-2044064 CLAIMS PROCESSING | Claims processing; Contract Administrator Service code 12 | — | $2K |
| ANSAY & ASSOCIATES INS AGENT OR BROKER | Insurance agents and brokers Service code 22 | PO BOX 45470 MADISON, WI 53744 | $1K |
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 | 249 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 3 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 256 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | WYSSTA INSURANCE COMPANY INC | 144 | $21K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 395 | $132K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 395 | $132K |
| Stop-loss / reinsurancereinsurance | TOKIO MARINE | 186 | $697K |
| Other | HARTFORD LIFE AND ACCIDENT | 395 | $132K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 395 | — |
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."
No prospect flags tripped on this filing.