| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ANSAY & ASSOCIATES LLC3 | 101 E GRAND AVE STE 200 PORT WASHINGTON, WI 53074 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $933 | $933 | 1.96% |
| ANSAY & ASSOCIATES LLC3 | 101 E GRAND AVE STE 200 PORT WASHINGTON, WI 53074 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $410 | $410 | 2.60% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $120K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 TPA (DENTAL BENEFIT) | Contract Administrator Service code 13 | — | $11K |
| EMPLOYEE BENEFITS CORPORATION EIN 39-2044064 CLAIMS PROCESSING | Claims processing; Contract Administrator Service code 12 | — | $2K |
| STEVE KLEBER INS AGENT OR BROKER | Insurance agents and brokers Service code 22 | 101 E GRAND AVE PORT WASHINGTON, WI 53074 | $138 |
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 | 235 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 4 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 240 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN | 568 | $32K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 221 | $63K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 210 | $524K |
| Other(4 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 221 | $95K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 568 | — |
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."
No prospect flags tripped on this filing.