| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | UNITEDHEALTHCARE INSURANCE COMPANY | $15K | — | $15K | 2.43% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENY INC. | 150 MAIN ST STE 300 MENASHA, WI 54952 | NETWORK HEALTH PLAN | $16K | $801 | $17K | 3.42% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | PO BOX 389 MENASHA, WI 549520389 | DELTA DENTAL OF WISCONSIN | $4K | — | $4K | 7.44% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | 150 MAIN ST STE 300 MENASHA, WI 549523386 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $1K | $5K | 26.13% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 4365 SOUTHWEST FWY STE 750 HOUSTON, TX 77027 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $394 | $394 | 2.04% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | 150 MAIN ST STE 300 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $991 | $3K | 20.09% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 4365 SOUTHWEST FWY STE 750 HOUSTON, TX 77027 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $330 | $330 | 1.91% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | 150 MAIN ST. STE 300 MENASHA, WI 549523386 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $810 | $810 | 5.47% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 4365 SOUTHWEST FWY STE. 750 HOUSTON, TX 77027 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $270 | $270 | 1.82% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | PO BOX 389 MENASHA, WI 54952 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $2K | — | $2K | 16.81% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | PO BOX 389 MENASHA, WI 549520389 | UNITEDHEALTHCARE INSURANCE COMPANY | $270 | — | $270 | 1.94% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | 150 MAIN ST STE 300 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $627 | $2K | 15.43% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 4365 SOUTHWEST FWY, STE. 750 HOUSTON, TX 77027 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $209 | $209 | 1.81% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | 150 MAIN STREET SUITE 300 MENASHA, WI 54952 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC. | $1K | — | $1K | 10.00% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | 150 MAIN ST STE 300 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $411 | $237 | $648 | 15.78% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 4365 SOUTHWEST FWY STE. 750 HOUSTON, TX 77027 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $79 | $79 | 1.92% |
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 | 149 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 149 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | UNITEDHEALTHCARE INSURANCE COMPANY | 114 | $645K |
| Dental | DELTA DENTAL OF WISCONSIN | 81 | $60K |
| Vision | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC. | 79 | $11K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 149 | $23K |
| Short-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 68 | $26K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 53 | $17K |
| Other(3 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 149 | $38K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 149 | — |
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.