| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | P.O. BOX 389 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $739 | $739 | 3.17% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH INSURANCE SVCS LLC | 501 OFFICE CENTER DR, STE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $329 | $329 | 1.41% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | P.O. BOX 389 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $744 | $744 | 3.87% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH INSURANCE SVCS LLC | 501 OFFICE CENTER DR, STE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $331 | $331 | 1.72% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | P.O. BOX 389 MENASHA, WI 54952 | TRANSAMERICA LIFE INSURANCE COMPANY | $3K | $0 | $3K | 20.12% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | P.O. BOX 389 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $292 | $292 | 3.65% |
| PATRIOT GROWTH INSURANCE SERVICES3 Filed as: PATRIOT GROWTH INSURANCE SVCS LLC | 501 OFFICE CENTER DR, STE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $130 | $130 | 1.63% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | P.O. BOX 389 MENASHA, WI 54952 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $166 | $0 | $166 | 12.54% |
| CAMERON SUTTON ROBERTS3 | N9404 ROSELLA DR APPLETON, WI 54915 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $7 | $3 | $10 | 0.76% |
| REBECCA STERNBERG3 | 374 MILFORD RD DEERFIELD, IL 60015 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | $0 | $5 | 0.38% |
| MICHAEL BLOCK3 | 16619 S. PINECREEK DRIVE LOCKPORT, IL 60441 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $0 | $2 | 0.15% |
| DAVID TODD WEINSTEIN3 | 7862 WEST IRLO BRONSON MEM HWY KISSIMMEE, FL 34747 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $0 | $2 | 0.15% |
| AMY E COHEN3 | 19967 VILLA LANTE PLACE BOCA RATON, FL 33434 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.08% |
| FELTER INC3 | 5403 COMMONWEALTH AVE WESTERN SPRINGS, IL 60558 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.08% |
| NORMAC SOLUTIONS INC3 | 451 HOPKINS ROAD TOWNVILLE, SC 29689 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.08% |
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 | 106 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 108 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HCC LIFE INSURANCE COMPANY | 65 | $366K |
| Dental(2 contracts, 2 carriers) | HCC LIFE INSURANCE COMPANY | 65 | $371K |
| Vision | VISION SERVICE PLAN | 49 | $9K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 106 | $27K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 106 | $23K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 65 | $366K |
| Other(5 contracts, 4 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 106 | $48K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 106 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.