Form 5500 · Employee benefit plan · RIO, WI
MD GROUP, LLC DBA HOMETOWN PHARMACY
MD GROUP, LLC DBA HOMETOWN PHARMACY of RIO, WI files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is AVERGENT LLC. Coverage is written through DELTA DENTAL OF WISCONSIN and 2 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 16-1637149 · plan 502 · as of Aug 2026
Plan brief
Schedule A lists 3 insured contracts covering dental, vision, life and disability; the largest, with DELTA DENTAL OF WISCONSIN, covers 171 people.
Reported premium across the insured contracts is $228,005, with $15,104 in disclosed broker commissions — about 6.6% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
AVERGENT LLC is the broker of record on all 3 contracts.
3 carriers appear on the filing — DELTA DENTAL OF WISCONSIN, THE PRUDENTIAL INSURANCE COMPANY OF AMERICA and WYSSTA INSURANCE COMPANY INC — with DELTA DENTAL OF WISCONSIN writing the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| DELTA DENTAL OF WISCONSIN | Dental | 171 | December | $160,346 | $8,659 |
| THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | Life, Disability | 91 | December | $50,827 | $5,083 |
| WYSSTA INSURANCE COMPANY INC | Vision | 150 | December | $16,832 | $1,362 |
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