Form 5500 · Employee benefit plan · GREEN BAY, WI
POMP'S TIRE SERVICE, INC.
The filing calls this plan POMP'S TIRE SERVICE VISION INSURANCE.
POMP'S TIRE SERVICE, INC. of GREEN BAY, WI is a 1,639-participant retail employer — a large group whose insured benefits are disclosed on Schedule A of its Form 5500. Its broker of record is JA COUNTER & ASSOCIATES. Coverage is written through WYSSTA INSURANCE COMPANY INC. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 39-0838986 · plan 508 · plan year 2025, filed Jul 31, 2026
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How this plan is funded
Funding not settled by the filing
The filing does not report enough to settle how this plan pays for benefits.
Benefits declared on this filing
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
The filing discloses a single insured line, vision, through WYSSTA INSURANCE COMPANY INC, covering 1,645 people.
Reported premium is $161,902; the filing discloses no broker commission on these contracts.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| WYSSTA INSURANCE COMPANY INC | Vision | 1,645 | Jan 1, 2026 | $161,902 | $0 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Reported to OSHA
Reported to OSHA for 2025: 1,199 employees, 58 recordable cases, 940 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
2 establishments filed under this EIN are left out of these figures: the hours and employees they reported could not both be right.
Other plans filed by this employer
How this plan compares
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