| 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 | MEDICA INSURANCE COMPANY | $28K | $2K | $30K | 3.18% |
| J A COUNTER & ASSOCIATES INC3 Filed as: J A COUNTER & ASSOCIATES | PO BOX 387 NEW RICHMOND, WI 54017 | DELTA DENTAL OF WISCONSIN | $8K | — | $8K | 9.54% |
| J A COUNTER & ASSOCIATES INC3 | 1477 S KNOWLES AVE STE 200 NEW RICHMOND, WI 54017 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $1K | $4K | 15.46% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK SUITE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $692 | $692 | 2.73% |
| J A COUNTER & ASSOCIATES INC3 | 1477 S KNOWLES AVE STE 200 NEW RICHMOND, WI 54017 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $1K | $4K | 20.93% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK SUITE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $575 | $575 | 3.31% |
| 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 | $837 | $3K | 20.90% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK SUITE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $418 | $418 | 2.95% |
| J A COUNTER & ASSOCIATES INC3 Filed as: J A COUNTER & ASSOCIATES | PO BOX 387 NEW RICHMOND, WI 54017 | WYSSTA INSURANCE COMPANY INC | $651 | — | $651 | 8.02% |
| 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 | $766 | $366 | $1K | 14.78% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK SUITE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $183 | $183 | 2.39% |
| 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 | $529 | $200 | $729 | 13.77% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK SUITE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $100 | $100 | 1.89% |
| 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 | $510 | $238 | $748 | 14.65% |
| NATIONAL BENEFIT CENTER3 | 23825 COMMERCE PARK SUITE A BEACHWOOD, OH 44122 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $119 | $119 | 2.33% |
| HEARTLAND BENEFITS GROUP LLC4 | 3120 CASTLETON XING SUN PRAIRIE, WI 53590 | PRE-PAID LEGAL SERVICES INC DBA LEGALSHIELD | $28 | — | $28 | 6.71% |
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 | 108 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 111 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MEDICA INSURANCE COMPANY | 162 | $943K |
| Dental | DELTA DENTAL OF WISCONSIN | 79 | $79K |
| Vision | WYSSTA INSURANCE COMPANY INC | 62 | $8K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 108 | $22K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 108 | $25K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 32 | $17K |
| Other(6 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 108 | $50K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 162 | — |
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.