| 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 | $27K | $0 | $27K | 3.55% |
| CROSS INSURANCE3 | 491 MAIN STREET BANGOR, ME 04401 | HARVARD PILGRIM HEALTH CARE OF NE INC - MA | $6K | $0 | $6K | 0.74% |
| CROSS INSURANCE3 | 1100 ELM STREET MANCHESTER, NH 03101 | HPHC INSURANCE COMPANY | $10K | $0 | $10K | 3.37% |
| CROSS INSURANCE3 | 491 MAIN STREET BANGOR, ME 04401 | HPHC INSURANCE COMPANY | $2K | $0 | $2K | 0.70% |
| FIAI INC3 Filed as: FIAI, INC. | 1100 ELM STREET MANCHESTER, NH 03101 | DELTA DENTAL PLAN OF NEW HAMPSHIRE, INC. | $4K | $0 | $4K | 5.00% |
| COMBINED SERVICES LLC3 | PO BOX 1320 CONCORD, NH 03302 | DELTA DENTAL PLAN OF NEW HAMPSHIRE, INC. | $731 | $0 | $731 | 0.85% |
| CROSS INSURANCE3 Filed as: CROSS INSURANCE, INC. NEW HAMPSHIRE | 1100 ELM STREET MANCHESTER, NH 03101 | ANTHEM LIFE INSURANCE COMPANY | $10K | $0 | $10K | 14.84% |
| CROSS BENEFIT SOLUTIONS3 | 116 COMMUNITY DRIVE, SUITE 2 AUGUSTA, ME 04330 | ANTHEM LIFE INSURANCE COMPANY | $0 | $559 | $559 | 0.87% |
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 | 119 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 119 | 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 | 336 | $1.1M |
| Dental | DELTA DENTAL PLAN OF NEW HAMPSHIRE, INC. | 136 | $86K |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 119 | $65K |
| Short-term disability | ANTHEM LIFE INSURANCE COMPANY | 119 | $65K |
| Long-term disability | ANTHEM LIFE INSURANCE COMPANY | 119 | $65K |
| Prescription drug(4 contracts, 2 carriers) | HARVARD PILGRIM HEALTH CARE OF NE INC - MA | 336 | $1.1M |
| Other | ANTHEM LIFE INSURANCE COMPANY | 119 | $65K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 336 | — |
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.