| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CROSS INSURANCE3 | PO BOX 1388 BANGOR, ME 04402 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $11K | $1K | $12K | 6.40% |
| CROSS INSURANCE3 | PO BOX 1388 BANGOR, ME 04402 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $12K | $622 | $13K | 15.76% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM HEALTH PLANS OF MAINE, INC EIN 31-1705652 CLAIM ADMINISTRATION | Float revenue; Other services; Claims processing; Contract Administrator; Other fees; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $185K |
| AMERITAS LIFE INSURANCE CORP EIN 47-0098400 CLAIMS PROCESSING | Claims processing Service code 12 | PO BOX 81889 LINCOLN, NE 68501 | $10K |
| WOODROW W CROSS AGENCY EIN 01-0378159 CLAIM ADMINISTRATION | Insurance agents and brokers; Insurance brokerage commissions and fees; Other commissions Service code 22 | 74 GILMAN ROAD BANGOR, ME 04401 | $0 |
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 | 380 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 380 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 380 | $277K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 380 | $194K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 380 | $194K |
| Stop-loss / reinsurancereinsurance | ANTHEM HEALTH PLANS OF MAINE, INC | 256 | $407K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 380 | $277K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 380 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.