| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CROSS INSURANCE3 Filed as: CROSS INSURANCE - BANGOR | 491 MAIN ST BANGOR, ME 04401 | HARVARD PILGRIM HEALTH CARE OF NE INC. - MA | $40K | $0 | $40K | 2.44% |
| CROSS BENEFIT SOLUTIONS3 Filed as: CROSS FINANCIAL INSURANCE | 1100 ELM STREET MANCHESTER, NH 03101 | HARVARD PILGRIM HEALTH CARE OF NE INC. - MA | $19K | $0 | $19K | 1.17% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE - BANGOR | 491 MAIN ST BANGOR, ME 04401 | HARVARD PILGRIM HEALTH CARE OF NE INC. - MA | $14K | $0 | $14K | 2.45% |
| CROSS BENEFIT SOLUTIONS3 Filed as: CROSS FINANCIAL INSURANCE | 1100 ELM STREET MANCHESTER, NH 03101 | HARVARD PILGRIM HEALTH CARE OF NE INC. - MA | $7K | $0 | $7K | 1.17% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE - BANGOR | 491 MAIN ST BANGOR, ME 04401 | HPHC INSURANCE COMPANY | $6K | $0 | $6K | 2.45% |
| CROSS BENEFIT SOLUTIONS3 Filed as: CROSS FINANCIAL INSURANCE | 1100 ELM STREET MANCHESTER, NH 03101 | HPHC INSURANCE COMPANY | $3K | $0 | $3K | 1.17% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE - BANGOR | 491 MAIN ST BANGOR, ME 04401 | HARVARD PILGRIM HEALTH CARE OF NE INC. - MA | $5K | $0 | $5K | 2.45% |
| CROSS BENEFIT SOLUTIONS3 Filed as: CROSS FINANCIAL INSURANCE | 1100 ELM STREET MANCHESTER, NH 03101 | HARVARD PILGRIM HEALTH CARE OF NE INC. - MA | $2K | $0 | $2K | 1.17% |
| FIAI INC3 Filed as: FIAI INC. | 1100 ELM STREET MANCHESTER, NH 03101 | ANTHEM LIFE INSURANCE COMPANY | $9K | $0 | $9K | 9.67% |
| CROSS BENEFIT SOLUTIONS3 | 116 COMMUNITY DRIVE SUITE 2 AUGUST, ME 04330 | ANTHEM LIFE INSURANCE COMPANY | $0 | $1K | $1K | 1.08% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE - BANGOR | 491 MAIN ST BANGOR, ME 04401 | HPHC INSURANCE COMPANY | $2K | $0 | $2K | 2.45% |
| CROSS BENEFIT SOLUTIONS3 Filed as: CROSS FINANCIAL INSURANCE | 1100 ELM STREET MANCHESTER, NH 03101 | HPHC INSURANCE COMPANY | $951 | $0 | $951 | 1.17% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE - BANGOR | 491 MAIN ST BANGOR, ME 04401 | HARVARD PILGRIM HEALTH CARE OF NE INC. - MA | $1K | $0 | $1K | 2.45% |
| CROSS BENEFIT SOLUTIONS3 Filed as: CROSS FINANCIAL INSURANCE | 1100 ELM STREET MANCHESTER, NH 03101 | HARVARD PILGRIM HEALTH CARE OF NE INC. - MA | $486 | $0 | $486 | 1.17% |
| FIAI INC3 Filed as: FIAI INC. | 1100 ELM STREET MANCHESTER, NH 03102 | RED TREE INSURANCE COMPANY, INC. | $2K | $0 | $2K | 10.20% |
| COMBINED SERVICES LLC3 | PO BOX 1320 CONCORD, NH 033021320 | RED TREE INSURANCE COMPANY, INC. | $304 | $0 | $304 | 1.53% |
| 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 | $19K |
| ANTHEM LIFE INSURANCE COMPANY EIN 35-0980405 ADMIN AGREEMENT | Claims processing; Contract Administrator; Other services; Float revenue; 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 03102 | $4K |
| COMBINED SERVICES LLC EIN 02-0479434 BROKER | Insurance agents and brokers Service code 22 | PO BOX 1320 CONCORD, NH 033021320 | $342 |
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 | 307 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 307 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(6 contracts, 2 carriers) | HARVARD PILGRIM HEALTH CARE OF NE INC. - MA | 278 | $2.8M |
| Vision | RED TREE INSURANCE COMPANY, INC. | 282 | $20K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 301 | $97K |
| Short-term disability | ANTHEM LIFE INSURANCE COMPANY | 301 | $97K |
| Long-term disability | ANTHEM LIFE INSURANCE COMPANY | 301 | $97K |
| 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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.