| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | BLUE CROSS & BLUE SHIELD OF WISCONSIN | $73K | — | $73K | 3.11% |
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 549520389 | DELTA DENTAL OF WISCONSIN | $16K | — | $16K | 9.09% |
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | $4K | $10K | 20.65% |
| 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 | $0 | $1K | $1K | 2.83% |
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 549520389 | WYSSTA INSURANCE COMPANY INC | $3K | — | $3K | 9.78% |
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54954 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $2K | $5K | 20.20% |
| 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 | $0 | $563 | $563 | 2.50% |
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $1K | $3K | 17.36% |
| 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 | $0 | $533 | $533 | 2.68% |
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $1K | $3K | 19.15% |
| 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 | $0 | $489 | $489 | 3.33% |
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $836 | $525 | $1K | 16.28% |
| 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 | $0 | $191 | $191 | 2.28% |
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $370 | $238 | $608 | 16.42% |
| 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 | $0 | $87 | $87 | 2.35% |
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 | 832 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 38 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 877 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS & BLUE SHIELD OF WISCONSIN | 368 | $2.3M |
| Dental | DELTA DENTAL OF WISCONSIN | 225 | $173K |
| Vision | WYSSTA INSURANCE COMPANY INC | 193 | $26K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 638 | $15K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 109 | $23K |
| Other(5 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 638 | $94K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 638 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.