| 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 | $55K | $0 | $55K | 3.20% |
| J.L. JONES AND ASSOCIATES3 | 720 COUNTRY CLUB ROAD, SUITE 100 EUGENE, OR 97401 | PACIFICSOURCE HEALTH PLANS | $5K | $0 | $5K | 2.61% |
| THOMAS W BOSTON3 Filed as: THOMAS W. BOSTON | 13661 MARKET AVENUE NORTH HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $2K | $0 | $2K | 9.79% |
| JMT INSURANCE INC3 Filed as: JMT INSURANCE INC. | 2985 DERR ROAD SPRINGFIELD, OH 45503 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $745 | $0 | $745 | 3.68% |
| BD CAPITAL PARTNERS LLC3 | 105 RIVERSIDE DRIVE DAYTON, OH 45405 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $403 | $0 | $403 | 1.99% |
| LINDA LEE BOSTON3 | 13661 MARKET AVENUE NORTH HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $239 | $0 | $239 | 1.18% |
| MJ INSURANCE3 Filed as: NICHOLE BOSTICK AND VARIOUS AGENTS | 1002 MORNING VIEW COURT ORRVILLE, OH 44667 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $80 | $0 | $80 | 0.40% |
| JAMES L HALSEY3 Filed as: JAMES L. HALSEY | 119 NORTH MAIN STREET UNION, OH 45322 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $68 | $0 | $68 | 0.34% |
| KATIE D DUER3 Filed as: KATIE D. DUER | 2801 SOUTH MEDINA LINE ROAD WADSWORTH, OH 44281 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $50 | $0 | $50 | 0.25% |
| J.L. JONES AND ASSOCIATES3 | 720 COUNTRY CLUB ROAD EUGENE, OR 97401 | STANDARD INSURANCE COMPANY | $2K | $0 | $2K | 8.89% |
| THOMAS W BOSTON3 Filed as: THOMAS W. BOSTON | 13661 MARKET AVENUE NORTH HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $973 | $0 | $973 | 5.69% |
| JMT INSURANCE INC3 Filed as: JMT INSURANCE INC. | 2985 DERR ROAD SPRINGFIELD, OH 45503 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $386 | $0 | $386 | 2.26% |
| LINDA LEE BOSTON3 | 13661 MARKET AVENUE NORTH HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $162 | $0 | $162 | 0.95% |
| JAMES L HALSEY3 Filed as: JAMES L. HALSEY | 119 NORTH MAIN STREET UNION, OH 45322 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $77 | $0 | $77 | 0.45% |
| NICHOLE L. BOSTICK3 Filed as: NICHOLE BOSTICK | 1002 MORNING VIEW COURT ORRVILLE, OH 44667 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $58 | $0 | $58 | 0.34% |
| THOMAS W BOSTON3 Filed as: THOMAS W. BOSTON | 13661 MARKET AVENUE NORTH HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $1K | $0 | $1K | 7.58% |
| JMT INSURANCE INC3 Filed as: JMT INSURANCE INC. | 2985 DERR ROAD SPRINGFIELD, OH 45503 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $532 | $0 | $532 | 3.83% |
| EUGENE HUDOCK3 | 36380 CHURCHILL DRIVE SOLON, OH 44139 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $291 | $0 | $291 | 2.09% |
| LINDA LEE BOSTON3 | 13661 MARKET AVENUE NORTH HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $288 | $0 | $288 | 2.07% |
| BD CAPITAL PARTNERS LLC3 | 105 RIVERSIDE DRIVE DAYTON, OH 45405 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $175 | $0 | $175 | 1.26% |
| JAMES L HALSEY3 Filed as: JAMES L. HALSEY | 119 NORTH MAIN STREET UNION, OH 45322 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $96 | $0 | $96 | 0.69% |
| NICHOLE L. BOSTICK3 Filed as: NICHOLE BOSTICK | 1002 MORNING VIEW COURT ORRVILLE, OH 44667 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $13 | $0 | $13 | 0.09% |
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 | 201 | 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) | 202 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | PACIFICSOURCE HEALTH PLANS | 355 | $1.9M |
| Dental(2 contracts) | PACIFICSOURCE HEALTH PLANS | 355 | $1.9M |
| Vision(2 contracts) | PACIFICSOURCE HEALTH PLANS | 355 | $1.9M |
| Life insurance | STANDARD INSURANCE COMPANY | 249 | $17K |
| Prescription drug(2 contracts) | PACIFICSOURCE HEALTH PLANS | 355 | $1.9M |
| Other(4 contracts, 2 carriers) | AMERICAN HERITAGE LIFE INSURANCE COMPANY | 249 | $68K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 355 | — |
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.