| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCCLONE AGENCY INC3 Filed as: THE MCCLONE AGENCY INC | 1807 ERIE AVE SHEBOYGAN, WI 53081 | NETWORK HEALTH INC | $21K | — | $21K | 0.39% |
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | SUNLIFE ASSURANCE COMPANY OF CANADA | $0 | $8K | $8K | 2.18% |
| 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 | 4.47% |
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $11K | $11K | $22K | 20.84% |
| MCCLONE AGENCY INC3 | 150 MAIN STREET PO BOX 389 MENASHA, WI 54952 | CARE-PLUS DENTAL PLANS, INC | $6K | — | $6K | 6.00% |
| BROKER NOT PROVIDED Filed as: NO BROKER | — | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CAPFINANCIAL PARTNERS, LLC EIN 26-0058143 CONSULTANT | Consulting fees Service code 70 | 4208 SIX FORKS ROAD SUITE 1700 RALEIGH, NC 27609 | $87K |
| MCCLONE INSURANCE GROUP | Custodial (securities) Service code 19 | — | $47K |
| CYPRESS BENEFIT ADMINISTRATORS, LLC EIN 39-1997579 CONTRACT ADMIN | Claims processing Service code 12 | 5560 W GRANDE MARKET DRIVE APPLETON, WI 54913 | $25K |
| MEDICAL EXCESS INSURANCE SERVICES EIN 46-0493280 CONTRACT ADMIN | Claims processing Service code 12 | DEPT 2173 LOS ANGELES, CA 90084 | $22K |
| DELTA DENTA OF WI EIN 39-6094742 TPA | Contract Administrator Service code 13 | 2801 HOOVER RD PO BOX 828 STEVENS POINT, WI 54481 | $20K |
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 | 773 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 38 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 811 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | NETWORK HEALTH INC | 497 | $5.4M |
| Dental | CARE-PLUS DENTAL PLANS, INC | 260 | $94K |
| Vision | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC | 877 | $66K |
| Life insurance(2 contracts, 2 carriers) | SUNLIFE ASSURANCE COMPANY OF CANADA | 1,007 | $541K |
| Long-term disability(2 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 767 | $261K |
| Prescription drug | NETWORK HEALTH INC | 497 | $5.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,007 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.