| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | MOUNTAIN CENTRAL PO BOX 62187 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $10K | $14K | 9.05% |
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 1.54% |
| USI INSURANCE SERVICES LLC3 | MOUNTAIN CENTRAL PO BOX 62187 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $5K | $8K | 10.67% |
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | — | $2K | 2.64% |
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WA 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $6K | — | $6K | 11.24% |
| USI INSURANCE SERVICES LLC3 | MOUNTAIN CENTRAL PO BOX 62187 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $4K | $6K | 11.15% |
| MCCLONE AGENCY INC3 | 150 MAIN STREET MENASHA, WI 54952 | SUPERIOR VISION PLAN OF WISCONSIN INC | $4K | — | $4K | 6.58% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES, LLC | PO BOX 62817 VIRGINIA BEACH, VA 23466 | SUPERIOR VISION PLAN OF WISCONSIN INC | $2K | — | $2K | 3.36% |
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | — | $3K | 15.07% |
| USI INSURANCE SERVICES LLC3 | MOUNTAIN CENTRAL PO BOX 62187 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $856 | $1K | $2K | 11.14% |
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 11.35% |
| USI INSURANCE SERVICES LLC3 | MOUNTAIN CENTRAL PO BOX 62187 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $331 | $637 | $968 | 10.64% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES LLC-MTN CENT | PO BOX 62187 VIRGINIA BEACH, VA 23466 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $201 | $641 | $842 | 10.31% |
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $616 | — | $616 | 7.55% |
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 | 373 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 7 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 380 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | SUPERIOR VISION PLAN OF WISCONSIN INC | 584 | $54K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 502 | $63K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 240 | $152K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 161 | $76K |
| Other(4 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 502 | $89K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 584 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.