| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CROSS INSURANCE3 | 1100 ELM STREET MANCHESTER, NH 03101 | HARVARD PILGRIM HEALTH CARE OF NE INC - MA | $29K | $0 | $29K | 2.02% |
| FIAI INC3 | 1100 ELM STREET MANCHESTER, NH 03101 | DELTA DENTAL PLAN OF NEW HAMPSHIRE, INC | $5K | $0 | $5K | 4.60% |
| CROSS INSURANCE3 | 1100 ELM STREET MANCHESTER, NH 03101 | DELTA DENTAL PLAN OF NEW HAMPSHIRE, INC | $359 | $0 | $359 | 0.37% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS5 | PO BOX 9201 AUSTIN, TX 78766 | METROPOLITAN LIFE INSURANCE COMPANY | $11K | $3K | $14K | 25.02% |
| GIS BENEFITS INC3 | 422 WAUPONSEE STREET MORRIS, IL 60450 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $749 | $749 | 1.38% |
| CROSS BENEFIT SOLUTIONS3 | 116 COMMUNITY DRIVE, SUITE 2 AUGUSTA, ME 04330 | METROPOLITAN LIFE INSURANCE COMPANY | $0 | $682 | $682 | 1.26% |
| CROSS INSURANCE3 | 1100 ELM STREET MANCHESTER, NH 03101 | VISION SERVICE PLAN | $757 | $0 | $757 | 7.35% |
| GIS BENEFITS INC3 Filed as: GIS NATIONAL | 9500 KOGER AVENUE, SUITE 2000 SAINT PETERSBURG, FL 33702 | METLIFE LEGAL PLANS | $446 | $0 | $446 | 26.90% |
| FIAI INC3 | 1100 ELM STREET MANCHESTER, NH 03101 | METLIFE LEGAL PLANS | $166 | $0 | $166 | 10.01% |
| BOON CHAPMAN BENEFIT ADMINISTRATORS5 | PO BOX 9201 AUSTIN, NH 78766 | METLIFE LEGAL PLANS | $0 | $84 | $84 | 5.07% |
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 | 125 | 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) | 125 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HARVARD PILGRIM HEALTH CARE OF NE INC - MA | 0 | $1.4M |
| Dental | DELTA DENTAL PLAN OF NEW HAMPSHIRE, INC | 172 | $98K |
| Vision | VISION SERVICE PLAN | 77 | $10K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 125 | $54K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 125 | $54K |
| Prescription drug | HARVARD PILGRIM HEALTH CARE OF NE INC - MA | 0 | $1.4M |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 125 | $56K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 172 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.