| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| J.L. JONES AND ASSOCIATES3 | 720 COUNTRY CLUB ROAD, SUITE 100 EUGENE, OR 97401 | PACIFICSOURCE HEALTH PLANS | $49K | — | $49K | 3.17% |
| THOMAS W BOSTON3 Filed as: THOMAS W. BOSTON | 1275 WEST MAPLE STREET HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $3K | — | $3K | 7.12% |
| JMT INSURANCE INC3 Filed as: JMT INSURANCE, INC. | 2985 DERR ROAD SPRINGFIELD, OH 45503 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $1K | — | $1K | 3.15% |
| LINDA LEE BOSTON3 Filed as: LINDA L. STALF-BOSTON | 13661 MARKET AVENUE NORTH HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $642 | — | $642 | 1.67% |
| JAMES L HALSEY3 Filed as: JAMES L. HALSEY | 119 NORTH MAIN STREET UNION, OH 45322 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $201 | — | $201 | 0.52% |
| NICHOLE L. BOSTICK3 Filed as: NICHOLE L. MASSIE | 1063 EAGLE DRIVE APARTMENT 708 AKRON, OH 44312 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $132 | — | $132 | 0.34% |
| KATIE D DUER3 Filed as: KATIE D. DUER | 2801 SOUTH MEDINA LINE ROAD WADSWORTH, OH 44281 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $71 | — | $71 | 0.18% |
| MJ INSURANCE3 Filed as: MARY POALSON AND VARIOUS AGENTS | 2801 SOUTH MEDINA LINE ROAD WADSWORTH, OH 44281 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $18 | — | $18 | 0.05% |
| J.L. JONES AND ASSOCIATES3 | 720 COUNTRY CLUB ROAD EUGENE, OR 97401 | STANDARD INSURANCE COMPANY | $2K | — | $2K | 8.94% |
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 | 245 | 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) | 245 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PACIFICSOURCE HEALTH PLANS | 346 | $1.5M |
| Dental | PACIFICSOURCE HEALTH PLANS | 346 | $1.5M |
| Vision | PACIFICSOURCE HEALTH PLANS | 346 | $1.5M |
| Life insurance | STANDARD INSURANCE COMPANY | 245 | $17K |
| Prescription drug | PACIFICSOURCE HEALTH PLANS | 346 | $1.5M |
| Other(2 contracts, 2 carriers) | AMERICAN HERITAGE LIFE INSURANCE COMPANY | 245 | $56K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 346 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.