| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| NELSON FINANCIAL GROUP LLC3 Filed as: NELSON FINANCIAL SERVICES | 2493 4TH AVENUE WEST DICKINSON, ND 58601 | AMERICAN NATIONAL INSURANCE COMPANY | $35K | — | $35K | — |
| GROUP BENEFIT SERVICES INC3 Filed as: GROUP BENEFIT SERVICES, INC. | 1736 E SUNSHINE ST STE 200 SPRINGFIELD, MO 65804 | AMERICAN NATIONAL INSURANCE COMPANY | $18K | — | $18K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PHCS / MULTIPLAN EIN 13-3068979 PPO NETWORK | Other fees Service code 99 | 3345 MICHELSON DRIVE, STE. 200 IRVINE, CA 92612 | $15K |
| GROUP BENEFIT SERVICES, INC. EIN 43-1770779 PLAN ADMINISTRATOR | Claims processing; Plan Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | 1736 E SUNSHINE ST STE 200 SPRINGFIELD, MO 65804 | $13K |
| ADVANCED MEDICAL PRICING SOLUTIONS EIN 20-2149357 MEDICAL REVIEW | Other fees Service code 99 | PO BOX 921695 NORCROSS, GA 30010 | $11K |
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 | 51 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 51 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AMERICAN NATIONAL INSURANCE COMPANY | 51 | $0 |
| Prescription drug | AMERICAN NATIONAL INSURANCE COMPANY | 51 | $0 |
| Stop-loss / reinsurancereinsurance | AMERICAN NATIONAL INSURANCE COMPANY | 51 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 51 | — |
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."
No prospect flags tripped on this filing.