Form 5500 · Employee benefit plan · CANTON, MA
3 PHASE ELEVATOR CORPORATION
The filing calls this plan 3PHASE ELEVATOR HEALTH & WELFARE PLAN.
3 PHASE ELEVATOR CORPORATION of CANTON, MA is a 202-participant construction employer whose group benefits are disclosed in its annual Form 5500 filing. Its broker of record is USI INSURANCE SERVICES LLC. Coverage is written through BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. and 3 other carriers. The plan's most recent policy period ended in July.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 04-3360900 · plan 501 · plan year 2025, filed Feb 2, 2026
Get an email when this employer files a new Form 5500, and again about four months before its plan renews.
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
Also declared: death benefits, other welfare.
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
Schedule A lists 4 insured contracts covering health, dental, vision, life and disability; the largest, with BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC., covers 466 people.
Reported premium across the insured contracts is $2,917,502, with $68,030 in disclosed broker commissions — about 2.3% of premium.
The most recent policy period ended in July, and the plan year ends July 31. Group contracts typically renew on that annual cycle.
USI INSURANCE SERVICES LLC is the broker of record on 2 of the 4 contracts; the rest name a different broker or none.
4 carriers appear on the filing, including BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC., KAISER FOUNDATION HEALTH PLAN, INC., HARTFORD LIFE AND ACCIDENT and VISION SERVICE PLAN. BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | Health, Dental | 466 | Aug 1, 2025 | $2,463,937 | $45,966 |
| KAISER FOUNDATION HEALTH PLAN, INC. | Health | 36 | Jan 1, 2025 | $255,226 | $12,801 |
| HARTFORD LIFE AND ACCIDENT | Life, Disability | 198 | Aug 1, 2025 | $179,134 | $8,184 |
| VISION SERVICE PLAN | Vision | 146 | Aug 1, 2025 | $19,205 | $1,079 |
Premium and claims on this contract
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC., contract 4960438. For the contract year on this filing, the carrier reported $2,463,937 in premium earned and $2,051,352 in claims incurred. Dividing one by the other gives 83%.
- BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC., contract 4960438 reported $412,584 in retention.
Retention is what the carrier kept of the premium after claims, as reported: administration, commissions and other charges.
Only experience-rated contracts report these figures, so most filings leave them blank.
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.
Reported to OSHA
Reported to OSHA for 2025: 705 employees, 14 recordable cases, 656 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
One establishment filed under this EIN is left out of these figures: the hours and employees it reported could not both be right.
Other plans filed by this employer
How this plan compares
Subscribers see how this compares with similar plans in Massachusetts. A subscription also adds this plan's filing history and the renewal calendar for its state. See plans and prices
Without an account you can open 10 employer, broker and carrier pages a day, including through an AI assistant, and 50 a day with a free account. Paid plans are what keep these records free to read.
More employer plans in Massachusetts — largest plans, brokers, carriers and renewal months.