| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | PO BOX 389 MENASHA, WI 54952 | BLUECROSS BLUESHIELD OF ILLINOIS | $134K | $0 | $134K | 2.76% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | 150 MAIN ST STE 300 PO BOX 389 MENASHA, WI 54952 | SUN LIFE ASSURANCE COMPANY OF CANADA | $61K | $0 | $61K | 15.18% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | PO BOX 389 MENASHA, WI 54952 | DELTA DENTAL OF ILLINOIS | $5K | $0 | $5K | 15.77% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | 150 MAIN ST STE 300 PO BOX 389 MENASHA, WI 54952 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $1K | $0 | $1K | 35.81% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | 222 S RIVERSIDE PLAZA STE 900 CHICAGO, IL 60606 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $111 | $0 | $111 | 2.72% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | 150 MAIN ST STE 300 PO BOX 389 MENASHA, WI 54952 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $924 | $0 | $924 | 25.96% |
| USI INSURANCE SERVICES LLC3 Filed as: USI INSURANCE SERVICES | 222 S RIVERSIDE PLAZA STE 900 CHICAGO, IL 60606 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $122 | $0 | $122 | 3.43% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY, INC. | 150 MAIN ST STE 300 PO BOX 389 MENASHA, WI 54952 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $476 | $0 | $476 | 14.75% |
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 | 545 | 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) | 545 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUECROSS BLUESHIELD OF ILLINOIS | 723 | $4.9M |
| Dental | DELTA DENTAL OF ILLINOIS | 392 | $31K |
| Vision | SUN LIFE ASSURANCE COMPANY OF CANADA | 545 | $400K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 545 | $400K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 545 | $400K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 545 | $400K |
| Other(3 contracts, 2 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 545 | $407K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 723 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.