| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | UNITEDHEALTHCARE INSURANCE COMPANY | $16K | — | $16K | 3.84% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | PO BOX 389 MENASHA, WI 549520389 | DELTA DENTAL OF WISCONSIN | $5K | — | $5K | 7.08% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | PO BOX 389 MENASHA, WI 54952 | UNITEDHEALTHCARE INSURANCE COMPANY | $360 | — | $360 | 1.68% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | PO BOX 389 MENASHA, WI 549523386 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $4K | $1K | $5K | 25.78% |
| 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 | — | $423 | $423 | 2.10% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | PO BOX 389 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $925 | $3K | 20.25% |
| 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 | — | $337 | $337 | 2.06% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | PO BOX 389 MENASHA, WI 549523386 | UNITED OF OMAHA LIFE INSURANCE COMPANY | — | $744 | $744 | 5.07% |
| 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 | — | $271 | $271 | 1.85% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | PO BOX 389 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $864 | $2K | 15.98% |
| 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 | — | $314 | $314 | 2.17% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | PO BOX 389 MENASHA, WI 54952 | WYSSTA INSURANCE COMPANY INC | $761 | — | $761 | 7.92% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | PO BOX 389 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $503 | $275 | $778 | 15.45% |
| 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 | — | $100 | $100 | 1.99% |
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $681 | — | $681 | 14.58% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | PO BOX 389 MENASHA, WI 54952 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $335 | — | $335 | 11.57% |
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $267 | — | $267 | 10.05% |
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $145 | — | $145 | 8.87% |
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 | 151 | 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) | 151 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | UNITEDHEALTHCARE INSURANCE COMPANY | 60 | $448K |
| Dental | DELTA DENTAL OF WISCONSIN | 87 | $70K |
| Vision | WYSSTA INSURANCE COMPANY INC | 73 | $10K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 151 | $25K |
| Short-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 61 | $29K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 50 | $16K |
| Other(7 contracts, 3 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 151 | $39K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 151 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.