| 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 | $26K | $0 | $26K | 1.72% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE - MANCHESTER | 1100 ELM STREET MANCHESTER, NH 03101 | HARVARD PILGRIM HEALTH CARE OF NE INC. - MA | $10K | $0 | $10K | 1.72% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE - MANCHESTER | 1100 ELM STREET MANCHESTER, NH 03101 | HARVARD PILGRIM HEALTH CARE OF NE INC. - MA | $3K | $0 | $3K | 1.72% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE - MANCHESTER | 1100 ELM STREET MANCHESTER, NH 03101 | HPHC INSURANCE COMPANY | $3K | $0 | $3K | 1.72% |
| FIAI INC3 Filed as: FIAI INC. | 637 CHESTNUT STREET MANCHESTER, NH 03104 | ANTHEM LIFE INSURANCE COMPANY | $10K | $0 | $10K | 9.92% |
| CROSS BENEFIT SOLUTIONS3 | PO BOX 469 AUGUSTA, ME 04332 | ANTHEM LIFE INSURANCE COMPANY | $0 | $3K | $3K | 3.35% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE - MANCHESTER | 1100 ELM STREET MANCHESTER, NH 03101 | HPHC INSURANCE COMPANY | $1K | $0 | $1K | 1.72% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE - MANCHESTER | 1100 ELM STREET MANCHESTER, NH 03101 | HARVARD PILGRIM HEALTH CARE OF NE INC. - MA | $620 | $0 | $620 | 1.72% |
| FIAI INC3 Filed as: FIAI, INC. | 1100 ELM STREET MANCHESTER, NH 03101 | RED TREE INSURANCE COMPANY, INC. | $2K | $0 | $2K | 9.83% |
| COMBINED SERVICES LLC3 | PO BOX 1320 CONCORD, NH 033021320 | RED TREE INSURANCE COMPANY, INC. | $281 | $0 | $281 | 1.47% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE - MANCHESTER | 1100 ELM STREET MANCHESTER, NH 03101 | HARVARD PILGRIM HEALTH CARE OF NE INC. - MA | $104 | $0 | $104 | 1.72% |
| 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 | $27K |
| ANTHEM LIFE INSURANCE COMPANY EIN 35-0980405 ADMIN AGREEMENT | Claims processing; Contract Administrator; Float revenue; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | 3075 VANDERCAR WAY CINCINNATI, OH 45209 | $9K |
| FIAI INC. EIN 43-2116581 BROKER | Insurance agents and brokers Service code 22 | 1100 ELM STREET MANCHESTER, NH 03101 | $5K |
| COMBINED SERVICES LLC EIN 02-0479434 BROKER | Insurance agents and brokers Service code 22 | PO BOX 1320 CONCORD, NH 033021320 | $1K |
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 | 316 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 316 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(7 contracts, 2 carriers) | HARVARD PILGRIM HEALTH CARE OF NE INC. - MA | 279 | $2.6M |
| Vision | RED TREE INSURANCE COMPANY, INC. | 284 | $19K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 296 | $96K |
| Long-term disability | ANTHEM LIFE INSURANCE COMPANY | 296 | $96K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 296 | — |
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."
No prospect flags tripped on this filing.