| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCCLONE AGENCY INC3 | 150 MAIN ST, STE 300 MENASHA, WI 54952 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | $16K | $16K | 1.25% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | 150 MAIN ST, STE 300 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $5K | $5K | $10K | 8.08% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 501 OFFICE CENTER DR, STE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $2K | $2K | 1.68% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | 150 MAIN ST, STE 300 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $2K | $6K | 11.30% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 501 OFFICE CENTER DR, STE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $844 | $844 | 1.56% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | 150 MAIN ST, STE 300 MENASHA, WI 54952 | WYSSTA INSURANCE COMPANY INC. | $4K | $0 | $4K | 8.00% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | 150 MAIN ST, STE 300 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $2K | $8K | 16.86% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 501 OFFICE CENTER DR, STE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $759 | $759 | 1.70% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | 150 MAIN ST, STE 300 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $5K | 13.06% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 501 OFFICE CENTER DR, STE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $670 | $670 | 1.80% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | 150 MAIN ST, STE 300 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $511 | $3K | 18.51% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 501 OFFICE CENTER DR, STE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $227 | $227 | 1.56% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | 150 MAIN ST, STE 300 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $400 | $2K | 19.02% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 501 OFFICE CENTER DR, STE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $178 | $178 | 1.79% |
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 | 396 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 400 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SUN LIFE ASSURANCE COMPANY OF CANADA | 316 | $1.3M |
| Vision | WYSSTA INSURANCE COMPANY INC. | 323 | $45K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 400 | $82K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 107 | $54K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 400 | $121K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 316 | $1.3M |
| Other(5 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 400 | $119K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 400 | — |
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.