| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | P.O. BOX 389 MENASHA, WI 54952 | DELTA DENTAL OF WISCONSIN | $6K | $0 | $6K | 7.04% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | P.O. BOX 389 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $995 | $3K | 16.91% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GI GEORGE PARENT LP | 501 OFFICE CENTER DR STE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $442 | $442 | 2.18% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | P.O. BOX 389 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $784 | $3K | 19.74% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GI GEORGE PARENT LP | 501 OFFICE CENTER DR STE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $348 | $348 | 2.11% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | P.O. BOX 389 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $648 | $3K | 24.96% |
| GALLAGHER BENEFIT SERVICES, INC.3 Filed as: GI GEORGE PARENT LP | 501 OFFICE CENTER DR STE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $288 | $288 | 2.21% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | P.O. BOX 389 MENASHA, WI 54952 | WYSSTA INSURANCE COMPANY INC. | $6K | $0 | $6K | 80.10% |
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 | 98 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 98 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 178 | $1.4M |
| Dental | DELTA DENTAL OF WISCONSIN | 60 | $80K |
| Vision | WYSSTA INSURANCE COMPANY INC. | 60 | $7K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 100 | $20K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 100 | $17K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 48 | $13K |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 116 | $25K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 178 | — |
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.