| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HEALTH PLANS, INC.3 Filed as: HEALTH PLANS INC, MA | 1500 WEST PARK DRIVE SUITE 300 WESTBOROUGH, MA 01581 | UNIMERICA INSURANCE COMPANY | $20K | — | $20K | 3.00% |
| CROSS INSURANCE3 | 491 MAIN ST. BANGOR, ME 04401 | LIFE INSURANCE COMPANY OF NORTH AMERICA LONG TERM DISABILITY PLAN | $22K | $3K | $25K | 13.96% |
| CROSS INSURANCE3 | 491 MAIN. ST BANGOR, ME 04401 | LIFE INSURANCE COMPANY OF NORTH AMERICA LIFE INSURANCE PLAN | $10K | $2K | $12K | 11.66% |
| CROSS INSURANCE3 | 491 MAIN ST. BANGOR, ME 04401 | LIFE INSURANCE COMPANY OF NORTH AMERICA SHORT TERM DISABILITY PLAN | $8K | $2K | $10K | 10.03% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE AGENCY | 116 COMMUNITY DR. STE 2 PO BOX 469 AUGUSTA, ME 043320469 | RED TREE INSURANCE COMPANY, INC. | $3K | — | $3K | 9.12% |
| COMBINED SERVICES LLC3 | PO BOX 1320 CONCORD, NH 033021320 | RED TREE INSURANCE COMPANY, INC. | $509 | — | $509 | 1.49% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE AGENCY | 74 GILMAN RD. PO BOX 1388 BANGOR, ME 04401 | RED TREE INSURANCE COMPANY, INC. | $282 | — | $282 | 0.83% |
| CROSS INSURANCE3 | 491 MAIN ST. BANGOR, ME 04401 | LIFE INSURANCE COMPANY OF NORTH AMERICA ACCIDENTAL DEATH PLAN | $2K | $358 | $2K | 11.56% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL PLAN OF MAINE EIN 01-0286541 DENTAL CLAIMS PROCESSING | Claims processing Service code 12 | ONE DELTA DRIVE CONCORD, NH 033022002 | $31K |
| BUSINESS INS. AGENCY DBA CROSS INS EIN 01-0508976 BROKER | Insurance agents and brokers Service code 22 | 116 COMMUNITY DRIVE STE 2 AUGUSTA, ME 043320469 | $5K |
| CROSS INSURANCE AGENCY EIN 01-0378159 BROKER | Insurance agents and brokers Service code 22 | 74 GILMAN RD. BANGOR, ME 04401 | $496 |
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 | 0 | 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) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNIMERICA INSURANCE COMPANY | 510 | $655K |
| Vision | RED TREE INSURANCE COMPANY, INC. | 791 | $34K |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA LIFE INSURANCE PLAN | 616 | $125K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA SHORT TERM DISABILITY PLAN | 616 | $103K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA LONG TERM DISABILITY PLAN | 616 | $178K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 791 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.