Form 5500 · Employee benefit plan · BOOTHBAY, ME
KNICKERBOCKER GROUP
The filing calls this plan KNICKERBOCKER GROUP EMPLOYEE BENEFITS PLANS.
KNICKERBOCKER GROUP of BOOTHBAY, ME insures health, dental, vision, life and disability coverage for its employees, per Schedule A of its Form 5500. Its broker of record is HUB INTERNATIONAL NEW ENGLAND LLC. Coverage is written through CIGNA HEALTH AND LIFE INSURANCE COMPANY and 3 other carriers. The plan's most recent policy period ended in August.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 01-0389577 · plan 501 · plan year 2025, filed Apr 9, 2026
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
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 128 people.
Reported premium across the insured contracts is $1,432,856, with $11,913 in disclosed broker commissions — about 0.8% of premium.
The most recent policy period ended in August, and the plan year ends August 31. Group contracts typically renew on that annual cycle.
HUB INTERNATIONAL NEW ENGLAND LLC is the broker of record on all 4 contracts.
4 carriers appear on the filing, including CIGNA HEALTH AND LIFE INSURANCE COMPANY, DELTA DENTAL PLAN OF MAINE, UNUM LIFE INSURANCE COMPANY OF AMERICA and DELTA VISION - RED TREE INSURANCE CO. CIGNA HEALTH AND LIFE INSURANCE COMPANY writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| UNUM LIFE INSURANCE COMPANY OF AMERICA | Life, Disability | 93 | Sep 1, 2025 | $64,092 | $6,503 |
| DELTA DENTAL PLAN OF MAINE | Dental | 162 | Sep 1, 2025 | $84,700 | $4,320 |
| DELTA VISION - RED TREE INSURANCE CO | Vision | 139 | Sep 1, 2025 | $9,284 | $1,090 |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY | Health | 128 | Sep 1, 2025 | $1,274,780 | $0 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Other plans filed by this employer
How this plan compares
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