| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CROSS INSURANCE3 Filed as: CROSS INSURANCE - MANCHESTER | 1100 ELM STREET MANCHESTER, NH 03101 | HARVARD PILGRIM HEALTH CARE OF NE INC. - MA | $38K | $0 | $38K | 2.42% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE - MANCHESTER | 1100 ELM STREET MANCHESTER, NH 03101 | HARVARD PILGRIM HEALTH CARE OF NE INC - MA | $4K | $0 | $4K | 2.42% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE - MANCHESTER | 1100 ELM STREET MANCHESTER, NH 03101 | HPHC INSURANCE COMPANY | $3K | $0 | $3K | 2.49% |
| FIAI INC3 Filed as: FIAI INC. | 1100 ELM STREET MANCHESTER, NH 03101 | ANTHEM LIFE INSURANCE COMPANY | $10K | $0 | $10K | 14.80% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE - MANCHESTER | 1100 ELM STREET MANCHESTER, NH 03101 | HPHC INSURANCE COMPANY | $1K | $0 | $1K | 2.42% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL PLAN OF NH INC EIN 02-0273013 DENTAL CLAIMS PROCESSING | Claims processing Service code 12 | ONE DELTA DRIVE CONCORD, NH 033022002 | $21K |
| ANTHEM LIFE INSURANCE COMPANY EIN 35-0980405 INSURANCE PROVIDER | Contract Administrator; Claims processing; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Float revenue Service code 12 | 120 MONUMENT CIRCLE INDIANAPOLIS, IN 46204 | $7K |
| FIAI, INC. DBA CROSS INSURANCE EIN 43-2116581 BROKER | Insurance agents and brokers Service code 22 | 1100 ELM STREET MANCHESTER, NH 03101 | $3K |
| BENEFIT STRATEGIES EIN 26-0003294 HRA/FSA CLAIMS ADMINISTRA | Claims processing; Contract Administrator Service code 12 | 967 ELM STREET PO BOX 1300 MANCHESTER, NH 03105 | $2K |
| COMBINED SERVICES LLC EIN 02-0479434 BROKER | Insurance agents and brokers Service code 22 | ONE DELTA DRIVE, SUITE 301 CONCORD, NH 03302 | $808 |
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 | 252 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 252 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 2 carriers) | HARVARD PILGRIM HEALTH CARE OF NE INC. - MA | 301 | $1.9M |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 244 | $68K |
| Long-term disability | ANTHEM LIFE INSURANCE COMPANY | 244 | $68K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 301 | — |
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.