| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ANSAY & ASSOCIATES LLC3 | 101 E GRAND AVE STE 11 PORT WASHINGTON, WI 53074 | GUARDIAN | — | $5K | $5K | 1.36% |
| ANSAY & ASSOCIATES LLC3 Filed as: ANSAY & ASSOCIATES | 101 E GRAND AVE #11 PORT WASHINGTON, WI 53074 | UNITEDHEALTHCARE INSURANCE COMPANY | $3K | — | $3K | 8.09% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | FINANCIAL SPECIAL SERVICES PO BOX 1087 WAUSAU, WI 544021087 | $68K |
| DELTA DENTAL OF WI EIN 39-6094742 THIRD PARTY ADMINISTRATO | Contract Administrator; Insurance agents and brokers Service code 13 | PO BOX 828 STEVENS POINT, WI 544810828 | $8K |
| EMPLOYEE BENEFITS CORPORATION EIN 02-4904714 THIRD PARTY ADMINISTRATO | Contract Administrator; Insurance agents and brokers Service code 13 | PO BOX 4437 MADISON, WI 537444347 | $2K |
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 | 182 | 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) | 182 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | GUARDIAN | 165 | $352K |
| Vision | GUARDIAN LIFE | 164 | $352K |
| Life insurance | UNITEDHEALTHCARE INSURANCE COMPANY | 182 | $33K |
| Short-term disability | UNITEDHEALTHCARE INSURANCE COMPANY | 182 | $33K |
| Other(4 contracts, 4 carriers) | GUARDIAN | 182 | $753K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 182 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.