| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| J.L. JONES AND ASSOCIATES3 Filed as: JL JONES AND ASSOCIATES | 720 COUNTRY CLUB ROAD EUGENE, OR 97401 | PACIFICSOURCE HEALTH PLANS | $72K | $0 | $72K | 3.55% |
| J.L. JONES AND ASSOCIATES3 Filed as: JL JONES AND ASSOCIATES | 720 COUNTRY CLUB ROAD EUGENE, OR 97401 | STANDARD INSURANCE COMPANY | $2K | $0 | $2K | 8.75% |
| THOMAS W BOSTON3 Filed as: THOMAS W. BOSTON | 13661 MARKET AVENUE NORTH HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $155 | $0 | $155 | 10.47% |
| JMT INSURANCE INC3 | 2986 DERR ROAD SPRINGFIELD, OH 45503 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $49 | $0 | $49 | 3.31% |
| BD CAPITAL PARTNERS LLC3 | 105 RIVERSIDE DRIVE DAYTON, OH 45405 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $23 | $0 | $23 | 1.55% |
| LINDA LEE BOSTON3 | 13661 MARKET AVENUE NORTH HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $19 | $0 | $19 | 1.28% |
| JAMES L HALSEY3 Filed as: JAMES L. HALSEY | 119 NORTH MAINSTREET UNION, OH 45322 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $7 | $0 | $7 | 0.47% |
| KATIE D DUER3 Filed as: KATIE D. DUER | 2801 SOUTH MEDINA LINE ROAD WADSWORTH, OH 44281 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $4 | $0 | $4 | 0.27% |
| NICHOLE L. BOSTICK3 Filed as: NICHOLE L. BOSTICK AND MISC. AGENTS | 222 WEST NORTH STREET MEDINA, OH 44256 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $4 | $0 | $4 | 0.27% |
| THOMAS W BOSTON3 Filed as: THOMAS W. BOSTON | 13661 MARKET AVENUE NORTH HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $61 | $0 | $61 | 5.64% |
| JMT INSURANCE INC3 | 2986 DERR ROAD SPRINGFIELD, OH 45503 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $24 | $0 | $24 | 2.22% |
| LINDA LEE BOSTON3 | 13661 MARKET AVENUE NORTH HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $10 | $0 | $10 | 0.92% |
| JAMES L HALSEY3 Filed as: JAMES L. HALSEY | 119 NORTH MAINSTREET UNION, OH 45322 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $5 | $0 | $5 | 0.46% |
| NICHOLE L. BOSTICK3 | 222 WEST NORTH STREET MEDINA, OH 44256 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $4 | $0 | $4 | 0.37% |
| ERICA J LEONHARDT3 Filed as: ERICA J. LEONHARDT | 9000 FRANCINE LANE POWELL, OH 43085 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $1 | $0 | $1 | 0.09% |
| DAVE MAUTE3 Filed as: DAVE MAUTE AND MISC. AGENTS | 2200 EAST MAIN STREET SPRINGFIELD, OH 45503 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $1 | $0 | $1 | 0.09% |
| THOMAS W BOSTON3 Filed as: THOMAS W. BOSTON | 13661 MARKET AVENUE NORTH HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $68 | $0 | $68 | 7.13% |
| JMT INSURANCE INC3 | 2986 DERR ROAD SPRINGFIELD, OH 45503 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $28 | $0 | $28 | 2.94% |
| BD CAPITAL PARTNERS LLC3 | 105 RIVERSIDE DRIVE DAYTON, OH 45405 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $24 | $0 | $24 | 2.52% |
| LINDA LEE BOSTON3 | 13661 MARKET AVENUE NORTH HARTVILLE, OH 44632 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $15 | $0 | $15 | 1.57% |
| EUGENE HUDOCK3 | 36380 CHURCHILL DRIVE SOLON, OH 44139 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $7 | $0 | $7 | 0.73% |
| JAMES L HALSEY3 Filed as: JAMES L. HALSEY | 119 NORTH MAINSTREET UNION, OH 45322 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $5 | $0 | $5 | 0.52% |
| NICHOLE L. BOSTICK3 | 222 WEST NORTH STREET MEDINA, OH 44256 | AMERICAN HERITAGE LIFE INSURANCE COMPANY | $1 | $0 | $1 | 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 | 192 | 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) | 192 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PACIFICSOURCE HEALTH PLANS | 316 | $2.0M |
| Dental | PACIFICSOURCE HEALTH PLANS | 316 | $2.0M |
| Vision | PACIFICSOURCE HEALTH PLANS | 316 | $2.0M |
| Life insurance | STANDARD INSURANCE COMPANY | 247 | $18K |
| Prescription drug | PACIFICSOURCE HEALTH PLANS | 316 | $2.0M |
| Other(4 contracts, 2 carriers) | STANDARD INSURANCE COMPANY | 247 | $22K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 316 | — |
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.