| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ANSAY & ASSOCIATES LLC3 | 2901 W BELTLINE HWY STE 202 MADISON, WI 53713 | SUN LIFE FINANCIAL | $0 | $25K | $25K | 1.78% |
| ANSAY & ASSOCIATES LLC3 | 2901 W BELTLINE HIGHWAY SUITE 202 MADISON, WI 53713 | HARTFORD LIFE AND ACCIDENT | $0 | $522 | $522 | 0.52% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SECURITY ADMINISTRATIVE SERVICES EIN 47-4820788 THIRD PARTY ADMIN | Claims processing Service code 12 | — | $136K |
| ANSAY & ASSOCIATES LLC EIN 27-1304628 CONSULTANT AND AGENT | Consulting (pension); Insurance agents and brokers Service code 17 | — | $66K |
| SECURITY HEALTH PLAN OF WISCONSIN EIN 39-1572880 OTHER SERVICES | Other services Service code 49 | — | $36K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMIN | Contract Administrator Service code 13 | — | $32K |
| RX BENEFITS EIN 63-1157085 PHARMACY ADMINISTRATOR | Claims processing Service code 12 | — | $16K |
| ZELIS EIN 86-1040704 NETWORK | Claims processing Service code 12 | — | $5K |
| HEALTH EOS BY MULTIPLAN EIN 13-3068979 NETWORK | Claims processing Service code 12 | — | $88 |
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 | 971 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 24 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 997 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | WYSSTA INSURANCE COMPANY INC | 471 | $60K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 1,006 | $100K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 1,006 | $100K |
| Stop-loss / reinsurancereinsurance | SUN LIFE FINANCIAL | 566 | $1.4M |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 1,006 | $160K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,006 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.