| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE INSURANCE CENTER3 Filed as: THE INSURANCE CENTER INC. | JEFF LECLAIRE 701 SAND LAKE ROAD ONALASKA, WI 546502442 | HEALTH TRADITION | $18K | — | $18K | 1.50% |
| THE INSURANCE CENTER3 Filed as: THE INSURANCE CENTER, INC. | 701 SAND LAKE ROAD ONALASKA, WI 54650 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $14K | — | $14K | 17.91% |
| TIC INC3 Filed as: TIC INC. | 701 SAND LAKE RD ONALASKA, WI 546502442 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | $228 | $7K | 15.52% |
| TIC INC3 Filed as: TIC INC. | 701 SAND LAKE RD ONALASKA, WI 54650 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 9.47% |
| TIC INC3 Filed as: TIC INC. | 701 SAND LAKE RD ONALASKA, WI 54650 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $249 | — | $249 | 12.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 TPA | Contract Administrator Service code 13 | — | $8K |
| THE INSURANCE CENTER INSURANCE AGENT | Insurance agents and brokers Service code 22 | 701 SAND LAKE ROAD ONALASKA, WI 546502442 | $1K |
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 | 134 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 136 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HEALTH TRADITION | 250 | $1.2M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 221 | $20K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 112 | $44K |
| Other(2 contracts, 2 carriers) | AMERICAN HERITAGE LIFE INSURANCE COMPANY | 221 | $79K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 250 | — |
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.