| 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 | $35K | $0 | $35K | 2.47% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE - MANCHESTER | 1100 ELM STREET MANCHESTER, NH 03101 | HARVARD PILGRIM HEALTH CARE OF NE INC - MA | $9K | $0 | $9K | 2.47% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE - MANCHESTER | 1100 ELM STREET MANCHESTER, NH 03101 | HPHC INSURANCE COMPANY | $3K | $0 | $3K | 2.47% |
| FIAI INC3 Filed as: FIAI INC. | 1100 ELM STREET MANCHESTER, NH 03101 | ANTHEM LIFE INSURANCE COMPANY | $9K | $0 | $9K | 13.28% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE - MANCHESTER | 1100 ELM STREET MANCHESTER, NH 03101 | HPHC INSURANCE COMPANY | $1K | $0 | $1K | 2.47% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE - MANCHESTER | 1100 ELM STREET MANCHESTER, NH 03101 | HARVARD PILGRIM HEALTH CARE OF NE INC - MA | $1K | $0 | $1K | 2.47% |
| FIAI INC3 Filed as: FIAI INC. DBA CROSS INSURANCE | 1100 ELM STREET MANCHESTER, NH 03101 | RED TREE INSURANCE COMPANY, INC. | $734 | $0 | $734 | 8.98% |
| COMBINED SERVICES LLC3 | PO BOX 1320 CONCORD, NH 033021320 | RED TREE INSURANCE COMPANY, INC. | $110 | $0 | $110 | 1.35% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE - MANCHESTER | 1100 ELM STREET MANCHESTER, NH 03101 | HARDVARD PILGRIM HEALTH CARE OF NE INC - MA | $123 | $0 | $123 | 2.46% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL PLAN OF NEW HAMPSHIRE, EIN 02-0273013 DENTAL CLAIMS PROCESSING | Claims processing Service code 12 | ONE DELTA DRIVE CONCORD, NH 033022002 | $22K |
| ANTHEM LIFE INSURANCE COMPANY EIN 35-0980405 INSURANCE PROVIDER | Float revenue; Claims processing; Other services; Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) 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 | $4K |
| COMBINED SERVICES LLC EIN 02-0479434 BROKER | Insurance agents and brokers Service code 22 | PO BOX 1320 CONCORD, NH 03302 | $873 |
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 | 267 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 267 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(6 contracts, 3 carriers) | HARVARD PILGRIM HEALTH CARE OF NE INC - MA | 276 | $2.0M |
| Vision | RED TREE INSURANCE COMPANY, INC. | 121 | $8K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 236 | $67K |
| Long-term disability | ANTHEM LIFE INSURANCE COMPANY | 236 | $67K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 276 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.