| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CLARK INSURANCE3 | PO BOX 3543 PORTLAND, ME 041040000 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $26K | — | $26K | 3.02% |
| BUSINESS INSURANCE AGENCY DBA CROSS3 Filed as: BUSINESS INS AGENCY DBA CROSS INS | PO BOX 469 AUGUSTA, ME 043320000 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $8K | — | $8K | 0.98% |
| CLARK INSURANCE3 | 1945 CONGRESS ST BLDG A PO BOX 3543 PORTLAND, ME 041043543 | DELTA DENTAL OF MAINE | $3K | — | $3K | 3.29% |
| CROSS BENEFIT SOLUTIONS3 | 116 COMMUNITY DR STE 2 PO BOX 469 AUGUSTA, ME 043320469 | DELTA DENTAL OF MAINE | $1K | — | $1K | 1.26% |
| COMBINED SERVICES LLC3 Filed as: COMBINED SERVICES LLC DBA CSONE BEN | PO BOX 1320 CONCORD, NH 033021320 | DELTA DENTAL OF MAINE | $710 | — | $710 | 0.80% |
| CLARK INSURANCE3 | 2385 CONGRESS ST PO BOX 3543 PORTLAND, ME 04102 | CIGNA GROUP INSURANCE | $2K | — | $2K | 5.85% |
| CROSS BENEFIT SOLUTIONS3 | 2367 CONGRESS STREET PORTLAND, ME 04332 | CIGNA GROUP INSURANCE | $2K | — | $2K | 5.31% |
| CLARK INSURANCE3 | 2385 CONGRESS ST PO BOX 3543 PORTLAND, ME 04102 | CIGNA GROUP INSURANCE | $2K | — | $2K | 5.61% |
| CROSS BENEFIT SOLUTIONS3 | 2367 CONGRESS STREET PORTLAND, ME 04332 | CIGNA GROUP INSURANCE | $928 | — | $928 | 3.31% |
| CLARK INSURANCE3 | 2385 CONGRESS ST PO BOX 3543 PORTLAND, ME 04102 | CIGNA GROUP INSURANCE | $1K | — | $1K | 7.10% |
| CROSS BENEFIT SOLUTIONS3 | 2367 CONGRESS STREET PORTLAND, ME 04332 | CIGNA GROUP INSURANCE | $776 | — | $776 | 4.90% |
| CLARK INSURANCE3 | 1945 CONGRESS ST #A PORTLAND, ME 04102 | VISION SERVICE PLAN | $580 | — | $580 | 4.83% |
| CLARK INSURANCE3 | 2385 CONGRESS ST PO BOX 3543 PORTLAND, ME 04102 | CIGNA GROUP INSURANCE | $183 | — | $183 | 7.44% |
| CROSS BENEFIT SOLUTIONS3 | 2367 CONGRESS STREET PORTLAND, ME 04332 | CIGNA GROUP INSURANCE | $112 | — | $112 | 4.55% |
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 | 132 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 134 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 132 | $862K |
| Dental | DELTA DENTAL OF MAINE | 227 | $88K |
| Vision | VISION SERVICE PLAN | 105 | $12K |
| Life insurance | CIGNA GROUP INSURANCE | 90 | $16K |
| Short-term disability | CIGNA GROUP INSURANCE | 58 | $28K |
| Long-term disability | CIGNA GROUP INSURANCE | 54 | $41K |
| Other | CIGNA GROUP INSURANCE | 90 | $2K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 227 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.