| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | P.O. BOX 389 MENASHA, WI 54952 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $11K | $0 | $11K | 5.52% |
| PROSENTIAL BENEFITS LLC3 Filed as: PROSENTIAL GROUP LLC | 40 TIOGA WAY, STE 230 MARBLEHEAD, MA 01945 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $2K | $2K | 0.83% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | P.O. BOX 389 MENASHA, WI 54952 | WYSSTA INSURANCE COMPANY INC. | $2K | $0 | $2K | 8.09% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | P.O. BOX 389 MENASHA, WI 54952 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 18.37% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | P.O. BOX 389 MENASHA, WI 54952 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $365 | $0 | $365 | 5.40% |
| PROSENTIAL BENEFITS LLC3 Filed as: PROSENTIAL GROUP LLC | 40 TIOGA WAY, STE 230 MARBLEHEAD, MA 01945 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $55 | $55 | 0.81% |
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 | 195 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 197 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | WYSSTA INSURANCE COMPANY INC. | 119 | $24K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 185 | $200K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 185 | $193K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 185 | $193K |
| Stop-loss / reinsurancereinsurance | TOKIO MARINE HCC | 166 | $480K |
| Other(4 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 604 | $216K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 604 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.