| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| T I C INC3 Filed as: T.I.C., INC. | 701 SAND LAKE RD ONALASKA, WI 546502442 | DELTA DENTAL OF WISCONSIN | $5K | — | $5K | 9.07% |
| T I C INC3 | 701 SAND LAKE RD ONALASKA, WI 54650 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $1K | $5K | 17.90% |
| NATIONAL BENEFIT CENTER3 | ATTN DENISE STEFANOFF 23825 COMMERCE PARK BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $710 | $710 | 2.65% |
| T I C INC3 | 701 SAND LAKE RD ONALASKA, WI 54650 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $1K | $5K | 20.59% |
| NATIONAL BENEFIT CENTER3 | ATTN DENISE STEFANOFF 23825 COMMERCE PARK BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $729 | $729 | 2.79% |
| TIC INC3 | 701 SAND LAKE RD ONALASKA, WI 54650 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $3K | — | $3K | 16.41% |
| TIC INC3 | 701 SAND LAKE RD ONALASKA, WI 54650 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $3K | — | $3K | 17.66% |
| T I C INC3 | 701 SAND LAKE RD ONALASKA, WI 54650 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 14.99% |
| TIC INC3 | 701 SAND LAKE RD ONALASKA, WA 54650 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $1K | — | $1K | 18.49% |
| T I C INC3 Filed as: T.I.C., INC. | 701 SAND LAKE RD ONALASKA, WI 546502442 | WYSSTA INSURANCE COMPANY INC | $445 | — | $445 | 7.99% |
| T I C INC3 | 701 SAND LAKE RD ONALASKA, WI 546502442 | METROPOLITAN LIFE INSURANCE COMPANY | $652 | — | $652 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ALLEGIANCE BENEFIT MANAGEMENT, INC. EIN 81-0400550 PLAN MANAGEMENT | Claims processing Service code 12 | — | $25K |
| ALLEGIANCE CARE MANAGEMENT, INC. EIN 03-0507057 CARE MANAGEMENT | Claims processing Service code 12 | — | $3K |
| ALLEGIANCE COBRA SERVICES, INC. EIN 71-0916514 COBRA SERVICES | Claims processing Service code 12 | — | $1K |
| EMPLOYEE BENEFITS CORPORATION EIN 39-2044064 THIRD PARTY ADMINISTRATO | Claims processing; Contract Administrator Service code 12 | — | $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 | 130 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 3 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 133 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF WISCONSIN | 66 | $51K |
| Vision | WYSSTA INSURANCE COMPANY INC | 51 | $6K |
| Life insurance(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 107 | $9K |
| Stop-loss / reinsurancereinsurance | SWISS RE CORPORATE SOLUTIONS AMERICA INS. CORP. | 70 | $271K |
| Other(8 contracts, 4 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 115 | $108K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 115 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.