| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ANSAY & ASSOCIATES LLC3 | 2901 W BELTLINE HIGHWAY SUITE 202 MADISON, WI 53713 | HARTFORD LIFE AND ACCIDENT | — | $643 | $643 | 0.47% |
| TYLER DAHLKE/DAHLKE INC3 | 212811 EMMET RD MOSINEE, WI 54455 | ILLINOIS MUTUAL LIFE INSURANCE COMPANY | $1K | — | $1K | 4.09% |
| ADVANTAGE GROUP GA LLC3 | 510 ALDERSON STREET SCHOFIELD, WI 54476 | ILLINOIS MUTUAL LIFE INSURANCE COMPANY | $1K | — | $1K | 3.24% |
| KIM MARQUARDT/ MARQUARDT INSURANCE3 | 5712 HIDDEN RIVER CIRCLE WESTON, WI 54476 | ILLINOIS MUTUAL LIFE INSURANCE COMPANY | $673 | — | $673 | 1.89% |
| ADVANTAGE GROUP GA LLC3 Filed as: ADVANTAGE GROUP MGA LLC | 510 ALDERSON STREET SCHOFIELD, WI 54476 | ILLINOIS MUTUAL LIFE INSURANCE COMPANY | $574 | — | $574 | 1.61% |
| REGGIE JORGENSEN3 | 8414 CALLON AVE WESTON, WI 54476 | ILLINOIS MUTUAL LIFE INSURANCE COMPANY | $2 | — | $2 | 0.01% |
| JOSHUA MULDER3 | 408 WAUSAU ST. BIRNAMWOOD, WI 54414 | ILLINOIS MUTUAL LIFE INSURANCE COMPANY | $1 | — | $1 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SECURITY ADMINISTRATIVE SERVICES EIN 47-4820788 THIRD PARTY ADMIN | Claims processing Service code 12 | — | $145K |
| EVO FIRST, INC EIN 92-1199332 PHARMACY BENEFIT MANAGER | Claims processing Service code 12 | — | $45K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMIN | Contract Administrator Service code 13 | — | $38K |
| ZELIS EIN 86-1040704 NETWORK | Claims processing Service code 12 | — | $31K |
| COTIVITI EIN 56-2059380 CLAIM EDITING FEES | Other fees Service code 99 | — | $12K |
| FH GROUP CORP EIN 13-3068979 NETWORK | Claims processing Service code 12 | 23291 NETWORK PLACE CHICAGO, IL 60673 | $912 |
| ANSAY & ASSOCIATES INSUR AGENT OR BROKER | Insurance agents and brokers Service code 22 | 975 INDIANHEAD DR MOSINEE, WI 54455 | $482 |
| HEALTHEOS BY MULTIPLAN EIN 13-3068979 NETWORK | Claims processing Service code 12 | — | $98 |
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 | 1,125 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 16 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,141 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | WYSSTA INSURANCE COMPANY INC | 500 | $65K |
| Life insurance(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 1,125 | $173K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 1,125 | $138K |
| Stop-loss / reinsurancereinsurance | PARTNERS MANAGING GENERAL UNDERWRITERS | 968 | $1.0M |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 1,125 | $173K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,125 | — |
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."
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.