| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY | 1807 ERIE AVE SHEBOYGAN, WI 53081 | NETWORK HEALTH PLAN | $6K | — | $6K | 0.13% |
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | STANDARD INSURANCE COMPANY | $11K | — | $11K | 6.69% |
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | STANDARD INSURANCE COMPANY | $7K | — | $7K | 4.74% |
| MCCLONE AGENCY INC3 | 150 MAIN STREET PO BOX 389 MENASHA, WI 54952 | CARE-PLUS DENTAL PLANS, INC | $4K | — | $4K | 6.00% |
| MCCLONE AGENCY INC3 | 150 MAIN STREET MENASHA, WI 54952 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC | $5K | — | $5K | 9.06% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SPECTRUM EIN 35-1801164 CONTRACT ADMIN | Claims processing Service code 12 | 41 EAST WASHINGTON STREET INDIANAPOLIS, IN 46202 | $308K |
| MCCLONE INSURANCE GROUP | Custodial (securities) Service code 19 | — | $39K |
| CYPRESS BENEFIT ADMINISTRATORS, LLC EIN 39-1997579 TPA | Claims processing Service code 12 | 5560 W GRANDE MARKET DRIVE APPLETON, WI 54913 | $21K |
| MEDICAL EXCESS INSURANCE SERVICES EIN 46-0493280 CONTRACT ADMIN | Claims processing Service code 12 | DEPT 2173 LOS ANGELES, CA 90084 | $20K |
| DELTA DENTAL OF WI EIN 39-6094742 TPA | Contract Administrator Service code 13 | 2801 HOOVER ROAD PO BOX 828 STEVENS POINT, WI 54481 | $19K |
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 | 722 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 14 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 736 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | NETWORK HEALTH PLAN | 442 | $5.1M |
| Dental | CARE-PLUS DENTAL PLANS, INC | 236 | $73K |
| Vision | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN INC | 732 | $54K |
| Life insurance | STANDARD INSURANCE COMPANY | 936 | $164K |
| Long-term disability | STANDARD INSURANCE COMPANY | 709 | $142K |
| Prescription drug | NETWORK HEALTH PLAN | 442 | $5.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 936 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.