| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CROSS INSURANCE3 Filed as: CROSS INSURANCE, INC. | 1100 ELM STREET MANCHESTER, NH 03101 | HARVARD PILGRIM HEALTH CARE OF NE INC - MA | $9K | $0 | $9K | 1.75% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE, INC. | PO BOX 133 BANGOR, ME 04402 | HARVARD PILGRIM HEALTH CARE OF NE INC - MA | $0 | $5K | $5K | 0.94% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE, INC. | 1100 ELM STREET MANCHESTER, NH 03101 | HPHC INSURANCE COMPANY | $1K | $0 | $1K | 2.00% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE, INC. | PO BOX 133 BANGOR, ME 04402 | HPHC INSURANCE COMPANY | $0 | $683 | $683 | 1.07% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE, INC. | 1100 ELM STREET MANCHESTER, NH 03101 | SUN LIFE ASSURANCE COMPANY OF CANADA | $2K | $0 | $2K | 6.85% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE, INC. | 1100 ELM STREET MANCHESTER, NH 03101 | RED TREE INSURANCE COMPANY, INC. | $218 | $0 | $218 | 10.27% |
| COMBINED SERVICES LLC3 | PO BOX 1320 CONCORD, NH 03302 | RED TREE INSURANCE COMPANY, INC. | $33 | $0 | $33 | 1.56% |
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 | 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)(2 contracts, 2 carriers) | HARVARD PILGRIM HEALTH CARE OF NE INC - MA | 163 | $566K |
| Vision | RED TREE INSURANCE COMPANY, INC. | 164 | $2K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 150 | $25K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 150 | $25K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 150 | $25K |
| Prescription drug(2 contracts, 2 carriers) | HARVARD PILGRIM HEALTH CARE OF NE INC - MA | 163 | $566K |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 150 | $25K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 164 | — |
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."
Final-filing indicator set. Plan is winding down; don't waste sales effort here.