Form 5500 · Employee benefit plan · BANGOR, ME
WHITE HOUSE MOTEL
The filing calls this plan LAFAYETTE HOTELS CONSOLIDATED WELFARE PLAN.
WHITE HOUSE MOTEL of BANGOR, ME is a 183-participant hospitality and food service employer whose group benefits are disclosed in its annual Form 5500 filing. Its broker of record is CROSS BENEFIT SOLUTIONS. Coverage is written through TRANSAMERICA LIFE INSURANCE COMPANY and 1 other carrier. The plan's most recent policy period ended in May.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 01-0381910 · plan 501 · plan year 2025, filed Dec 10, 2025
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How this plan is funded
Funding not settled by the filing
The filing does not report enough to settle how this plan pays for benefits.
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.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
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
All 2 insured contracts are life coverage, split across TRANSAMERICA LIFE INSURANCE COMPANY and PRINCIPAL LIFE INSURANCE COMPANY.
The filing declares life, health, dental and vision. Health, dental and vision appear with no insured contract on Schedule A. That coverage may be self-funded, or placed with a carrier that is not on this filing.
Reported premium across the insured contracts is $68,972, with $2,163 in disclosed broker commissions — about 3.1% of premium.
The most recent policy period ended in May, and the plan year ends May 31. Group contracts typically renew on that annual cycle.
CROSS BENEFIT SOLUTIONS is the broker of record on 1 of the 2 contracts; the rest name a different broker or none.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| TRANSAMERICA LIFE INSURANCE COMPANY | Life | 103 | Jun 1, 2025 | $57,262 | $1,412 |
| PRINCIPAL LIFE INSURANCE COMPANY | Life | 217 | Jun 1, 2025 | $11,710 | $751 |
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.
Other plans filed by this employer
How this plan compares
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