| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BRANDON MONDLOCK T.I.C INC.3 | 701 SAND LAKE RD ONALASKA, WI 546502442 | PREVEA360 HEALTH PLAN | $36K | — | $36K | 1.90% |
| T I C INC3 Filed as: T.I.C., INC. | 701 SAND LAKE RD ONALASKA, WI 546502442 | DELTA DENTAL OF WISCONSIN | $10K | — | $10K | 9.46% |
| 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 | — | $4K | $4K | 5.36% |
| NATIONAL BENEFIT CENTER3 | 3700 PARK EAST DR STE 350 BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $2K | $2K | 2.68% |
| 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 | $2K | $2K | $4K | 10.79% |
| T I C INC3 | 701 SAND LAKE RD ONALASKA, WI 54650 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 5.01% |
| NATIONAL BENEFIT CENTER3 | 3700 PARK EAST DR STE 350 BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $1K | $1K | 2.90% |
| 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 | $4K | $2K | $6K | 17.25% |
| T I C INC3 | 701 SAND LAKE RD ONALASKA, WI 54650 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | — | $4K | 10.89% |
| NATIONAL BENEFIT CENTER3 | 3700 PARK EAST DR STE 350 BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $1K | $1K | 3.07% |
| J A COUNTER & ASSOCIATES INC3 Filed as: JA COUNTER AND ASSOCIATES INC | 1477 S KNOWLES AVE STE 200 NEW RICHMOND, WI 540172543 | CONTINENTAL AMERICAN INSURANCE COMPANY | $3K | — | $3K | 9.35% |
| T I C INC3 | PAUL JACOBSON 701 SAND LAKE RD ONALASKA, WI 54650 | CONTINENTAL AMERICAN INSURANCE COMPANY | $2K | — | $2K | 5.12% |
| 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 | $1K | $1K | $3K | 11.01% |
| T I C INC3 | 701 SAND LAKE RD ONALASKA, WI 54650 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 4.98% |
| NATIONAL BENEFIT CENTER3 | 3700 PARK EAST DR STE 350 BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $705 | $705 | 2.99% |
| J A COUNTER & ASSOCIATES INC3 Filed as: J.A. COUNTER & ASSOCIATES INC | 1477 S KNOWLES AVE STE 200 NEW RICHMOND, WI 540172543 | VISION SERVICE PLAN | $821 | — | $821 | 3.98% |
| T I C INC3 Filed as: T.I.C., INC. | 701 SAND LAKE RD ONALASKA, WI 546502442 | VISION SERVICE PLAN | $682 | — | $682 | 3.31% |
| EMPLOYEE NAVIGATOR, LLC3 | 7979 OLD GEORGETOWN RD STE 300 BETHESDA, MD 208142554 | VISION SERVICE PLAN | $174 | — | $174 | 0.84% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPLOYEE BENEFITS CORPORATION EIN 39-2044064 CLAIMS PROCESSING | Contract Administrator; Claims processing Service code 12 | — | $1K |
| JA COUNTER & ASSOCIATES, INC. INS AGENTS AND BROKERS | Insurance agents and brokers Service code 22 | 1477 S KNOWLES AVE, STE 200 NEW RICHMOND, WI 54017 | $45 |
| THE INSURANCE CENTER INS AGENTS AND BROKERS | Insurance agents and brokers Service code 22 | 701 SAND LAKE RD ONALASKA, WI 54650 | $20 |
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 | 158 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 1 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 159 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PREVEA360 HEALTH PLAN | 298 | $1.9M |
| Dental | DELTA DENTAL OF WISCONSIN | 167 | $111K |
| Vision | VISION SERVICE PLAN | 168 | $21K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 270 | $24K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 270 | $77K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 270 | $39K |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 270 | $92K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 298 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.