| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ULTRABENEFITS, INC.1 Filed as: ULTRABENEFITS INC | 100 N. PARKWAY WORCESTER, MA 01605 | AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS (ANTEX) | — | $39K | $39K | 16.59% |
| TIMOTHY THOMPSON7 | 299 OCEAN HOUSE ROAD CAPE ELIZABETH, ME 04107 | AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS (ANTEX) | — | $20K | $20K | 8.60% |
| TIMOTHY ROONEY6 | 9462 BROWNSBORO RD LOUISVILLE, KY 40241 | AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS (ANTEX) | — | $20K | $20K | 8.60% |
| PATIENT ADVOCATES LLC4 | 25 SHAKER ROAD GRAY, ME 04039 | AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS (ANTEX) | $0 | $8K | $8K | 3.44% |
| MEDICAL NETWORK, INC2 Filed as: MEDICAL NETWORK INC. | PO BOX 780 SCARBOROUGH, ME 04070 | AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS (ANTEX) | $0 | $5K | $5K | 2.32% |
| PREMIER HEALTHCARE EXCHANGE3 | 2 CROSSROADS DRIVE BEDMINSTER, NJ 07921 | AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS (ANTEX) | $0 | $915 | $915 | 0.39% |
| CAREMARK5 | PO BOX 6590 LEES SUMMIT, MO 64064 | AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS (ANTEX) | $0 | $54 | $54 | 0.02% |
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 | 116 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 116 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS (ANTEX) | 116 | $237K |
| Dental | AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS (ANTEX) | 116 | $237K |
| Vision | AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS (ANTEX) | 116 | $237K |
| Life insurance | AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS (ANTEX) | 116 | $237K |
| Prescription drug | AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS (ANTEX) | 116 | $237K |
| Stop-loss / reinsurancereinsurance | AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS (ANTEX) | 116 | $237K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 116 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
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.