| 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 | $0 | $912 | $912 | 0.79% |
| TYLER DAHLKE/DAHLKE INC3 | 212811 EMMET RD MOSINEE, WI 54455 | ILLINOIS MUTUAL LIFE INSURANCE COMPANY | $12K | — | $12K | 31.86% |
| KIM MARQUARDT/ MARQUARDT INSURANCE3 | 5712 HIDDEN RIVER CIRCLE WESTON, WI 54476 | ILLINOIS MUTUAL LIFE INSURANCE COMPANY | $8K | — | $8K | 22.87% |
| ADVANTAGE GROUP GA LLC3 | 510 ALDERSON STREET SCHOFIELD, WI 54476 | ILLINOIS MUTUAL LIFE INSURANCE COMPANY | $7K | — | $7K | 18.53% |
| ADVANTAGE GROUP GA LLC3 Filed as: ADVANTAGE GROUP MGA LLC | 510 ALDERSON STREET SCHOFIELD, WI 54476 | ILLINOIS MUTUAL LIFE INSURANCE COMPANY | $3K | — | $3K | 9.27% |
| JOSHUA MULDER3 | 408 WAUSAU ST. BIRNAMWOOD, WI 54414 | ILLINOIS MUTUAL LIFE INSURANCE COMPANY | $93 | — | $93 | 0.26% |
| REGGIE JORGENSEN3 | 8414 CALLON AVE WESTON, WI 54476 | ILLINOIS MUTUAL LIFE INSURANCE COMPANY | $68 | — | $68 | 0.19% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SECURITY ADMINISTRATIVE SERVICES EIN 47-4820788 THIRD PARTY ADMIN | Claims processing Service code 12 | — | $127K |
| ZELIS EIN 86-1040704 NETWORK | Claims processing Service code 12 | — | $68K |
| ANSAY & ASSOCIATES LLC EIN 27-1304628 CONSULTANT | Consulting (pension) Service code 17 | — | $61K |
| SECURITY HEALTH PLAN OF WISCONSIN EIN 39-1572880 OTHER SERVICES | Other services Service code 49 | — | $33K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMIN | Contract Administrator Service code 13 | — | $33K |
| RX BENEFITS EIN 63-1157085 PHARMACY ADMINISTRATOR | Claims processing Service code 12 | — | $4K |
| BILL ABELL INS AGENT OR BROKER | Insurance agents and brokers Service code 22 | 975 INDIANHEAD DR MOSINEE, WI 54455 | $407 |
| HEALTH EOS BY MULTIPLAN EIN 13-3068979 NETWORK | Claims processing Service code 12 | — | $135 |
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 | 1,139 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 12 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,152 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | WYSSTA INSURANCE COMPANY INC | 484 | $61K |
| Life insurance(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 1,110 | $151K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 1,110 | $115K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 1,025 | $893K |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 1,110 | $151K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,110 | — |
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.