| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | P.O. BOX 389 MENASHA, WI 54952 | BLUE CROSS BLUE SHIELD OF WISCONSIN | $19K | $0 | $19K | 3.38% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | P.O. BOX 389 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $791 | $3K | 14.09% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 501 OFFICE CENTER DR, STE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $352 | $352 | 1.82% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | P.O. BOX 389 MENASHA, WI 54952 | METROPOLITAN LIFE INSURANCE COMPANY | $1K | $0 | $1K | 9.18% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | P.O. BOX 389 MENASHA, WI 54952 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $2K | $0 | $2K | 20.41% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | P.O. BOX 389 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $742 | $2K | 20.94% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 501 OFFICE CENTER DR, STE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $330 | $330 | 3.14% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | P.O. BOX 389 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $486 | $2K | 20.56% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 501 OFFICE CENTER DR, STE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $216 | $216 | 2.47% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | P.O. BOX 389 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $214 | $125 | $339 | 15.86% |
| PATRIOT GROWTH INSURANCE SERVICES3 | 501 OFFICE CENTER DR, STE 215 FORT WASHINGTON, PA 19034 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $0 | $56 | $56 | 2.62% |
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 | 105 | 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) | 106 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF WISCONSIN | 123 | $567K |
| Dental | DENTAL COM INSURANCE PLAN INC. | 57 | $42K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 120 | $12K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 106 | $11K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 59 | $19K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 51 | $11K |
| Other(4 contracts, 3 carriers) | AMERICAN HERITAGE LIFE INSURANCE COMPANY | 106 | $24K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 123 | — |
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.