| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCCLONE AGENCY INC3 Filed as: THE MCCLONE AGENCY INC | 150 MAIN ST STE 102 PO BOX 389 MENASHA, WI 54952 | NETWORK HEALTH PLAN | $6K | $27K | $33K | 0.51% |
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | — | $0 | 0.00% |
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | STANDARD INSURANCE COMPANY | $11K | $2K | $13K | 7.03% |
| MC CLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | STANDARD INSURANCE COMPANY | $6K | $1K | $7K | 4.20% |
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $10K | $10K | $20K | 20.04% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE INSURANCE INC | 150 MAIN STREET PO BOX 389 MENASHA, WI 54952 | CARE PLUS DENTAL PLANS INC | $6K | — | $6K | 6.00% |
| MCCLONE AGENCY INC | PO BOX 389 MENASHA, WI 54952 | SUPERIOR VISION PLAN | $9K | — | $9K | 10.00% |
| CYPRESS BENEFIT ADMINISTRATORS, LLC5 Filed as: CYPRESS BENEFIT ADMIN, LLC | 5560 WEST GRANDE MARKET DRIVE APPLETON, WI 54913 | HCC LIFE INSURANCE COMPANY | — | $664 | $664 | 3.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CAPFINANCIAL PARTNERS LLC EIN 26-0058143 CONSULTANT | Consulting fees Service code 70 | 4208 SIX FORKS RD SUITE 1700 RALEIGH, NC 27609 | $72K |
| MCCLONE INSURANCE GROUP | Custodial (securities) Service code 19 | — | $53K |
| CYPRESS BENEFIT ADMINISTRATORS LLC EIN 39-1997579 CONTRACT ADMIN | Claims processing Service code 12 | 5560 W GRANDE MARKET DR APPLETON, WI 54913 | $28K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 TPA | Contract Administrator Service code 13 | 2801 HOOVER ROAD PO BOX 828 STEVENS POINT, WI 54481 | $22K |
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 | 828 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 29 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 857 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | NETWORK HEALTH PLAN | 537 | $6.5M |
| Dental | CARE PLUS DENTAL PLANS INC | 267 | $96K |
| Vision | SUPERIOR VISION PLAN | 405 | $89K |
| Life insurance(2 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 1,076 | $604K |
| Long-term disability(2 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 822 | $274K |
| Prescription drug | NETWORK HEALTH PLAN | 537 | $6.5M |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 113 | $22K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,076 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.