| 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 | $2K | $2K | 4.26% |
| 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 | $588 | $588 | 1.55% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | P.O. BOX 389 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $2K | $2K | 4.92% |
| 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 | $549 | $549 | 1.79% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | 150 MAIN ST SUITE 300 MENASHA, WI 54952 | TRANSAMERICA LIFE INSURANCE COMPANY | $4K | $0 | $4K | 18.93% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | P.O. BOX 389 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $493 | $493 | 5.17% |
| 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 | $179 | $179 | 1.88% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | P.O. BOX 389 MENASHA, WI 54952 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $184 | $0 | $184 | 12.04% |
| ADAM J ZAHN3 | 725 E GRANT ST APPLETON, WI 54911 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $33 | $3 | $36 | 2.36% |
| CAMERON SUTTON ROBERTS3 | N9404 ROSELLA DR APPLETON, WI 54915 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $15 | $1 | $16 | 1.05% |
| REBECCA STERNBERG3 | 374 MILFORD RD DEERFIELD, IL 60015 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $5 | $0 | $5 | 0.33% |
| JEFFREY BISHOP FELTER3 | 1405 CRESTED IRIS WAY NORTH MYRTLE BEACH, SC 29582 | 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 | 122 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 123 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 67 | $16K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 122 | $10K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 122 | $31K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 84 | $511K |
| Other(5 contracts, 4 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 122 | $71K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 122 | — |
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.