| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| THE INSURANCE CENTER3 | 701 SAND LAKE ROAD ONALASKA, WI 54650 | GUNDERSEN HEALTH PLAN, INC. | $20K | — | $20K | 2.10% |
| T I C INC3 Filed as: T I C INC. | 701 SAND LAKE RD. ONALASKA, WI 546502442 | AMERITAS LIFE INSURANCE CORP. | $3K | — | $3K | 4.73% |
| T I C INC3 Filed as: T I C INC. | PENNY 701 SAND LAKE RD. ONALASKA, WI 546502442 | PRINCIPAL LIFE INSURANCE COMPANY | $5K | $191 | $5K | 12.59% |
| T I C INC3 Filed as: T I C, INC. | 701 SAND LAKE RD. ONALASKA, WI 54650 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $10K | — | $10K | 38.17% |
| T I C INC3 | 701 SAND LAKE RD ONALASKA, WI 546502442 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $711 | $3K | 15.82% |
| LA CROSSE INSURANCE AGENCY3 Filed as: LA CROSSE INS AGENCY INC | 305 5TH AVE S STE 204 LA CROSSE, WI 546014050 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $581 | — | $581 | 3.63% |
| T I C INC3 | 701 SAND LAKE RD ONALASKA, WI 546502442 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $440 | $242 | $682 | 11.90% |
| LA CROSSE INSURANCE AGENCY3 Filed as: LA CROSSE INS AGENCY INC | 305 5TH AVE S STE 204 LA CROSSE, WI 546014050 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $133 | — | $133 | 2.32% |
| T I C INC3 Filed as: T I C INC. | 701 SAND LAKE RD ONALASKA, WI 546502442 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $790 | — | $790 | 15.00% |
| T I C INC3 Filed as: T I C INC. | 701 SAND LAKE RD. ONALASKA, WI 546502442 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $254 | — | $254 | 10.00% |
No Schedule C service providers reported on this filing.
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 | 246 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 6 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 16 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 268 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | GUNDERSEN HEALTH PLAN, INC. | 224 | $982K |
| Dental | AMERITAS LIFE INSURANCE CORP. | 277 | $67K |
| Vision | AMERITAS LIFE INSURANCE CORP. | 277 | $67K |
| Life insurance(4 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 238 | $30K |
| Short-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 88 | $37K |
| Long-term disability | PRINCIPAL LIFE INSURANCE COMPANY | 88 | $37K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 238 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 277 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.