| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ANSAY & ASSOCIATES LLC3 | 101 E GRAND AVE PORT WASHINGTON, WI 53704 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | $34K | $34K | 2.53% |
| ANSAY & ASSOCIATES LLC3 | 101 E GRAND AVE STE 11 PORT WASHINGTON, WI 53074 | THE HARTFORD | $0 | $1K | $1K | 1.36% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SECURITY ADMINISTRATIVE SERVICES EIN 47-4820788 THIRD PARTY ADMIN | Claims processing Service code 12 | — | $176K |
| ANSAY & ASSOCIATES LLC EIN 27-1304628 INSURANCE AGENT | Consulting (pension); Insurance agents and brokers Service code 17 | 101 E GRAND AVE STE 11 PORT WASHINGTON, WI 53704 | $64K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMIN | Contract Administrator Service code 13 | — | $32K |
| HINES & ASSOCIATES EIN 36-3545085 OTHER SERVICES | Other services Service code 49 | — | $16K |
| PREMIER HEALTHCARE SOLUTIONS EIN 33-0054358 PHARMACY ADMINISTRATOR | Claims processing Service code 12 | — | $8K |
| PHX EIN 86-1040704 NETWORK | Claims processing Service code 12 | — | $8K |
| OPTUM HEALTH CARE SOLUTIONS EIN 41-1591944 OTHER SERVICES | Other services Service code 49 | — | $621 |
| HEALTH EOS BY MULTIPLAN EIN 39-1634980 NETWORK | Claims processing Service code 12 | — | $110 |
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 | 576 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 576 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | WYSSTA INSURANCE COMPANY INC | 455 | $62K |
| Life insurance | THE HARTFORD | 956 | $94K |
| Long-term disability | THE HARTFORD | 956 | $94K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,145 | $1.3M |
| Other(2 contracts, 2 carriers) | THE HARTFORD | 956 | $156K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,145 | — |
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.