| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | UNITEDHEALTHCARE INSURANCE COMPANY | $17K | — | $17K | 2.84% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | PO BOX 389 MENASHA, WI 54952 | UNITEDHEALTHCARE INSURANCE COMPANY | $16K | — | $16K | 3.17% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | PO BOX 389 MENASHA, WI 549520389 | UNITEDHEALTHCARE INSURANCE COMPANY | $2K | — | $2K | 2.21% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | PO BOX 389 MENASHA, WI 549520389 | DELTA DENTAL OF WISCONSIN | $5K | — | $5K | 7.33% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | 150 MAIN ST STE 300 MENASHA, WI 549523386 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $670 | $4K | 23.52% |
| PROSENTIAL BENEFITS LLC3 | 100 STONEWALL BLVD STE 1 WRENTHAM, MA 02093 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $167 | $167 | 0.88% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | PO BOX 389 MENASHA, WI 54952 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $3K | — | $3K | 17.13% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | 150 MAIN ST STE 300 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $564 | $3K | 18.27% |
| PROSENTIAL BENEFITS LLC3 | 100 STONEWALL BLVD STE 1 WRENTHAN, MA 02093 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $154 | $154 | 0.97% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | 150 MAIN ST. STE 300 MENASHA, WI 549523386 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $575 | $575 | 3.81% |
| PROSENTIAL BENEFITS LLC3 | 100 STONEWALL BLVD STE 1 WRENTHAM, MA 02093 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $166 | $166 | 1.10% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | 150 MAIN STREET SUITE 102 MENASHA, WI 54952 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC. | $1K | — | $1K | 10.03% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | 150 MAIN ST STE 300 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $848 | $268 | $1K | 13.15% |
| PROSENTIAL BENEFITS LLC3 | 100 STONEWALL BLVD STE 1 WRENTHAM, MA 02093 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $71 | $71 | 0.84% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | 150 MAIN ST STE 300 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $432 | $149 | $581 | 13.45% |
| PROSENTIAL BENEFITS LLC3 | 100 STONWALL BLVD STE 1 WRENTHAM, MA 02093 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $42 | $42 | 0.97% |
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 | 156 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 8 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 164 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts) | UNITEDHEALTHCARE INSURANCE COMPANY | 139 | $1.2M |
| Dental | DELTA DENTAL OF WISCONSIN | 83 | $66K |
| Vision | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC. | 141 | $13K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 156 | $23K |
| Short-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 73 | $24K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 56 | $16K |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 156 | $40K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 156 | — |
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."
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.