| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| J.L. JONES AND ASSOCIATES3 Filed as: JL JONES AND ASSOCIATES | 720 COUNTRY CLUB ROAD, SUITE 100 EUGENE, OR 97401 | PACIFICSOURCE HEALTH PLANS | $61K | $0 | $61K | 3.76% |
| J.L. JONES AND ASSOCIATES3 Filed as: JL JONES AND ASSOCIATES | 720 COUNTRY CLUB ROAD EUGENE, OR 97401 | STANDARD INSURANCE COMPANY | $1K | $0 | $1K | 9.03% |
| THOMAS W BOSTON3 Filed as: THOMAS W. BARTON | 13661 MARKET AVENUE N HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $2K | $0 | $2K | 12.45% |
| JMT INSURANCE INC3 Filed as: JMT INSURANCE INC. | 2895 DERR ROAD SPRINGFIELD, OH 45503 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $817 | $0 | $817 | 5.60% |
| LINDA LEE BOSTON3 | 13661 MARKET AVENUE N HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $322 | $0 | $322 | 2.21% |
| JAMES L HALSEY3 Filed as: JAMES L. HALSEY | 119 NORTH MAIN STREET UNION, OH 45322 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $59 | $0 | $59 | 0.40% |
| NICHOLE L. BOSTICK3 | 1002 MORNING VIEW COURT ORRVILLE, OH 44667 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $36 | $0 | $36 | 0.25% |
| KATIE D DUER3 Filed as: KATIE D. DUER | 2801 SOUTH MEDINA LINE ROAD WADSWORTH, OH 44281 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $35 | $0 | $35 | 0.24% |
| MJ INSURANCE3 Filed as: ERICA LEONHARDT AND VARIOUS AGENTS | 9000 FRANCINE LANE POWELL, OH 43065 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $24 | $0 | $24 | 0.16% |
| THOMAS W BOSTON3 Filed as: THOMAS W. BOSTON | 1275 WEST MAPLE STREET HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $932 | $0 | $932 | 6.78% |
| JMT INSURANCE INC3 Filed as: JMT INSURANCE INC. | 2985 DERR ROAD SPRINGFIELD, OH 45503 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $370 | $0 | $370 | 2.69% |
| LINDA LEE BOSTON3 | 13661 MARKET AVENUE NORTH HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $155 | $0 | $155 | 1.13% |
| JAMES L HALSEY3 Filed as: JAMES L. HALSEY | 119 NORTH MAIN STREET UNION, OH 45322 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $74 | $0 | $74 | 0.54% |
| NICHOLE L. BOSTICK3 | 1002 MORNING VIEW COURT ORRVILLE, OH 44667 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $45 | $0 | $45 | 0.33% |
| THOMAS W BOSTON3 Filed as: THOMAS W. BOSTON | 13661 MARKET AVENUE N HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $1K | $0 | $1K | 12.90% |
| JMT INSURANCE INC3 Filed as: JMT INSURANCE INC. | 2985 DERR ROAD SPRINGFIELD, OH 45503 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $963 | $0 | $963 | 8.57% |
| EUGENE HUDOCK3 | 36380 CHURCHILL DRIVE SOLON, OH 44139 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $763 | $0 | $763 | 6.79% |
| LINDA LEE BOSTON3 | 13661 MARKET AVENUE N HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $615 | $0 | $615 | 5.47% |
| JAMES L HALSEY3 Filed as: JAMES L. HALSEY | 119 NORTH MAIN STREET UNION, OH 45322 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $170 | $0 | $170 | 1.51% |
| NICHOLE L. BOSTICK3 | 1002 MORNING VIEW COURT ORRVILLE, OH 44667 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $11 | $0 | $11 | 0.10% |
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 | 207 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 208 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PACIFICSOURCE HEALTH PLANS | 361 | $1.6M |
| Dental | PACIFICSOURCE HEALTH PLANS | 361 | $1.6M |
| Vision | PACIFICSOURCE HEALTH PLANS | 361 | $1.6M |
| Life insurance | STANDARD INSURANCE COMPANY | 255 | $16K |
| Prescription drug | PACIFICSOURCE HEALTH PLANS | 361 | $1.6M |
| Other(4 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 255 | $56K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 361 | — |
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.