Form 5500 · Employee benefit plan · MARLBOROUGH, MA
AMBRI, INC.
The filing calls this plan AMBRI, INC. GROUP BENEFITS PLAN.
Public Form 5500 records show how AMBRI, INC. of MARLBOROUGH, MA, a manufacturing employer, structures its employee benefits. Its broker of record is GALLAGHER BENEFIT INSURANCE SERVICE. Coverage is written through BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. and 2 other carriers. The plan's most recent policy period ended in March.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 27-3220023 · plan 501 · plan year 2024, filed Sep 18, 2025
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How this plan is funded
Both, as reported
The medical insurance contracts on the filing cover fewer than half the people in the plan, so the rest is paid another way.
A stop-loss policy appears on a Form 5500 only when the plan itself is the beneficiary, or the premiums are paid from plan money. Many employers buy stop-loss and never report it here. So a plan with no stop-loss on its filing may still have it.
Benefits declared on this filing
Also declared: 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 7 insured contracts covering health, dental, vision, life and disability; the largest, with BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC., covers 55 people.
Reported premium across the insured contracts is $2,036,254, with $51,175 in disclosed broker commissions — about 2.5% of premium.
The most recent policy period ended in March, and the plan year ends March 31. Group contracts typically renew on that annual cycle.
GALLAGHER BENEFIT INSURANCE SERVICE is the broker of record on 2 of the 7 contracts; the rest name a different broker or none.
3 carriers appear on the filing, including BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC., SUN LIFE ASSURANCE COMPANY OF CANADA and EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO.. 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 | 55 | Apr 1, 2024 | $1,772,258 | $34,802 |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | Dental | 57 | Apr 1, 2024 | $108,238 | $4,469 |
| SUN LIFE ASSURANCE COMPANY OF CANADA | — | 175 | Apr 1, 2024 | $69,874 | $3,777 |
| SUN LIFE ASSURANCE COMPANY OF CANADA | Disability | 175 | Apr 1, 2024 | $32,862 | $3,647 |
| SUN LIFE ASSURANCE COMPANY OF CANADA | Life | 175 | Apr 1, 2024 | $27,240 | $2,058 |
| EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | Vision | 101 | Apr 1, 2024 | $13,949 | $1,282 |
| SUN LIFE ASSURANCE COMPANY OF CANADA | Disability | 175 | Apr 1, 2024 | $11,833 | $1,140 |
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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