| 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 | $23K | — | $23K | 3.01% |
| CROSS INSURANCE3 | PO BOX 1388 BANGOR, ME 04402 | LIFE INSURANCE COMPANY OF NORTH AMERICA SHORT TERM DISABILITY PLAN | $10K | — | $10K | 5.32% |
| CROSS INSURANCE3 | PO BOX 1388 BANGOR, ME 04402 | LIFE INSURANCE COMPANY OF NORTH AMERICA LIFE INSURANCE PLAN | $6K | — | $6K | 5.64% |
| BROWN AND BROWN OF FLORIDA, INC.3 Filed as: BROWN AND BROWN OF MASSACHUSETTS | 144 TURNPIKE RD. STE 330 SOUTHBOROUGH, MA 017722123 | RELIASTAR LIFE INSURANCE COMPANY | $10K | — | $10K | 10.00% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE AGENCY | 74 GILMAN RD. PO BOX 1388 BANGOR, ME 04401 | RED TREE INSURANCE COMPANY, INC. | $4K | — | $4K | 9.91% |
| COMBINED SERVICES LLC3 | PO BOX 1320 CONCORD, NH 033021320 | RED TREE INSURANCE COMPANY, INC. | $543 | — | $543 | 1.49% |
| 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 | $35K |
| CIGNA BEHAVIORAL HEALTH, INC. EIN 41-1648670 CONTRACTED WITH EMPLOYER | Participant communication; Direct payment from the plan; Claims processing; Contract Administrator Service code 12 | 11095 VIKING DRIVE EDEN PRAIRIE, MN 55344 | $13K |
| CROSS INSURANCE EIN 01-0378159 BROKER | Insurance agents and brokers Service code 22 | 74 GILMAN ROAD BANGOR, ME 04401 | $6K |
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 | 555 | $761K |
| Vision | RED TREE INSURANCE COMPANY, INC. | 880 | $37K |
| Life insurance | RELIASTAR LIFE INSURANCE COMPANY | 1,005 | $102K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA LIFE INSURANCE PLAN | 0 | $105K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA SHORT TERM DISABILITY PLAN | 0 | $193K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,005 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.