| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CGI EMPLOYEE BENEFITS GROUP3 | 171 LONDONDERRY TURNPIKE RD. HOOKSETT, NH 03106 | HARVARD PILGRIM HEALTH CARE | $150K | $0 | $150K | 3.99% |
| CGI EMPLOYEE BENEFITS GROUP3 Filed as: CGI EMPLOYEE BENEFITS | 171 LONDONDERRY TURNPIKE RD. HOOKSETT, NH 03106 | DELTA DENTAL PLAN OF NEW HAMPSHIRE, INC. | $8K | $0 | $8K | 3.16% |
| COMBINED SERVICES LLC3 Filed as: COMBINED SERVICES, LLC | PO BOX 1320 CONCORD, NH 033021320 | DELTA DENTAL PLAN OF NEW HAMPSHIRE, INC. | $2K | $0 | $2K | 0.74% |
| CGI EMPLOYEE BENEFITS GROUP3 | 171 LONDONDERRY TURNPIKE HOOKSETT, NH 03106 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $12K | $0 | $12K | 8.21% |
| CGI EMPLOYEE BENEFITS GROUP3 Filed as: CGI EMPLOYEE BENEFITS | 171 LONDONDERRY TURNPIKE RD. HOOKSETT, NH 03106 | RED TREE INSURANCE COMPANY, INC. | $3K | $0 | $3K | 9.89% |
| COMBINED SERVICES LLC3 Filed as: COMBINED SERVICES, LLC | PO BOX 1320 CONCORD, NH 033021320 | RED TREE INSURANCE COMPANY, INC. | $441 | $0 | $441 | 1.48% |
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 | 341 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 344 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HARVARD PILGRIM HEALTH CARE | 614 | $3.8M |
| Dental | DELTA DENTAL PLAN OF NEW HAMPSHIRE, INC. | 634 | $263K |
| Vision | RED TREE INSURANCE COMPANY, INC. | 450 | $30K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 346 | $141K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 346 | $141K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 346 | $141K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 346 | $141K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 634 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.