| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| J A COUNTER & ASSOCIATES INC3 Filed as: JA COUNTER & ASSOCIATES INC | 1477 S KNOWLES AVE STE 200 NEW RICHMOND, WI 54017 | DELTA DENTAL OF WISCONSIN | $2K | — | $2K | 1.79% |
| J A COUNTER & ASSOCIATES INC3 Filed as: JA COUNTER AND ASSOCIATES INC. | 1477 S KNOWLES AVE STE 200 NEW RICHMOND, WI 54017 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $10K | $2K | $11K | 17.81% |
| J A COUNTER & ASSOCIATES INC3 Filed as: J A COUNTER AND ASSOCIATES INC | 1477 S KNOWLES AVE STE 200 NEW RICHMOND, WI 54017 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $7K | $1K | $8K | 17.94% |
| J A COUNTER & ASSOCIATES INC3 Filed as: J A COUNTER AND ASSOCIATES INC | 1477 S KNOWLES AVE STE 200 NEW RICHMOND, WI 54017 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $1K | $1K | 2.91% |
| J A COUNTER & ASSOCIATES INC3 Filed as: JA COUNTER AND ASSOCIATES INC | 1477 S KNOWLES AVE STE 200 NEW RICHMOND, WI 54017 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $928 | $928 | 2.82% |
| J A COUNTER & ASSOCIATES INC3 Filed as: JA COUNTER AND ASSOCIATES INC. | PO BOX 387 NEW RICHMOND, WA 54017 | WYSSTA INSURANCE COMPANY INC | $1K | — | $1K | 8.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BENEFITS PLAN ADMINISTRATOR EIN 41-1479417 CLAIMS PROCESSING | Claims processing Service code 12 | — | $85K |
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 | 192 | 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) | 192 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF WISCONSIN | 172 | $87K |
| Vision | WYSSTA INSURANCE COMPANY INC | 107 | $15K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 269 | $79K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 333 | $43K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 151 | $64K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 192 | $681K |
| Other(3 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 269 | $143K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 333 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.