| 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 | $1K | $1K | 4.34% |
| 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 | $506 | $506 | 1.92% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | P.O. BOX 389 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $942 | $942 | 4.10% |
| 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 | $419 | $419 | 1.82% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | P.O. BOX 389 MENASHA, WI 54952 | TRANSAMERICA LIFE INSURANCE COMPANY | $3K | $0 | $3K | 18.59% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | P.O. BOX 389 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $390 | $390 | 4.61% |
| 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 | $174 | $174 | 2.06% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | P.O. BOX 389 MENASHA, WI 54952 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $201 | $0 | $201 | 14.49% |
| CAMERON SUTTON ROBERTS3 | N9404 ROSELLA DR APPLETON, WI 54915 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $22 | $5 | $27 | 1.95% |
| ADAM J ZAHN3 | 725 E GRANT ST APPLETON, WI 54911 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $16 | $10 | $26 | 1.87% |
| REBECCA STERNBERG3 | 374 MILFORD RD DEERFIELD, IL 60015 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | $0 | $5 | 0.36% |
| MICHAEL BLOCK3 | 16619 S. PINECREEK DRIVE LOCKPORT, IL 60441 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2 | $0 | $2 | 0.14% |
| DAVID TODD WEINSTEIN3 | 7862 WEST IRLO BRONSON MEM HWY KISSIMMEE, FL 34747 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.07% |
| FELTER INC3 | 5403 COMMONWEALTH AVE WESTERN SPRINGS, IL 60558 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.07% |
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 | 111 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 114 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CARE-PLUS DENTAL PLANS, INC. | 10 | $4K |
| Vision | VISION SERVICE PLAN | 58 | $12K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 111 | $31K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 111 | $26K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 69 | $381K |
| Other(5 contracts, 4 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 111 | $51K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 111 | — |
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.