| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| RICK JOHN HAGAN HAMILTON INSURANCE3 Filed as: RICK JOHN | P.O. BOX 847 MCMINNVILLE, OR 97128 | PROVIDENCE HEALTH PLAN | $0 | $0 | $0 | 0.00% |
| MJ INSURANCE3 Filed as: MJI, INC. | 448 SE BAKER ST. MCMINNVILLE, OH 97128 | STANDARD | $10K | $0 | $10K | 6.44% |
| MJ INSURANCE3 Filed as: MJI, INC. DBA HAGAN HAMILTON INS. | P.O. BOX 847 MCMINNVILLE, OR 97128 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 5.46% |
| MJ INSURANCE3 Filed as: MJI, INC. DBA HAGAN HAMILTON | P.O. BOX 847 MCMINNVILLE, OR 971280847 | AMERITAS | $2K | $0 | $2K | 6.53% |
| MJ INSURANCE3 Filed as: MJI, INC. | P.O. BOX 847 MCMINNVILLE, OR 97128 | AMERITAS | $6K | $175 | $6K | 39.86% |
| HAGAN HAMILTON INSURANCE3 Filed as: HAGAN HAMILTON | PO BOX 847 MCMINNVILLE, OR 97128 | HEALTHIEST YOU | $0 | $0 | $0 | 0.00% |
| DOUG A. SMITH4 Filed as: DOUG SMITH | 4751 ASTORIA ST NE SALEM, OR 97305 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $813 | $0 | $813 | 15.29% |
| MJ INSURANCE4 Filed as: MJI INC | PO BOX 847 MCMINNVILLE, OR 97128 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $541 | $0 | $541 | 10.17% |
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 | 180 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 10 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 190 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PROVIDENCE HEALTH PLAN | 130 | $1.5M |
| Dental | AMERITAS | 153 | $15K |
| Vision | AMERITAS | 140 | $27K |
| Life insurance(2 contracts, 2 carriers) | STANDARD | 188 | $203K |
| Short-term disability | STANDARD | 188 | $162K |
| Long-term disability | STANDARD | 188 | $162K |
| Other(2 contracts, 2 carriers) | HEALTHIEST YOU | 135 | $16K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 188 | — |
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."
No prospect flags tripped on this filing.