Form 5500 · Employee benefit plan · PORTSMOUTH, NH
BLUE MANTIS INC
BLUE MANTIS INC of PORTSMOUTH, NH files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is CROSS INSURANCE, INC.. Coverage is written through CIGNA HEALTH AND LIFE INSURANCE COMPANY and 3 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 01-0504323 · plan 505 · as of Aug 2026
Plan brief
Schedule A lists 4 insured contracts covering health, dental, vision, life and disability; the largest, with CIGNA HEALTH AND LIFE INSURANCE COMPANY, covers 347 people.
Reported premium across the insured contracts is $3,626,502, with $25,551 in disclosed broker commissions — about 0.7% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
CROSS INSURANCE, INC. is the broker of record on 3 of the 4 contracts; the rest name a different broker or none.
4 carriers appear on the filing — CIGNA HEALTH AND LIFE INSURANCE COMPANY, UNITED OF OMAHA LIFE INSURANCE COMPANY, EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. and COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY — with CIGNA HEALTH AND LIFE INSURANCE COMPANY writing the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life, Disability | 269 | December | $196,530 | $12,699 |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY | Health, Dental | 347 | December | $3,398,477 | $8,417 |
| EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | Vision | 771 | December | $26,292 | $3,729 |
| COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY | — | 12 | December | $5,203 | $706 |
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