Form 5500 · Employee benefit plan · JOHNSON CITY, TN
BORLA PERFORMANCE INDUSTRIES, INC.
The filing calls this plan BORLA PERFORMANCE INDUSTRIES, INC. HEALTH AND WELFARE PLAN.
BORLA PERFORMANCE INDUSTRIES, INC. of JOHNSON CITY, TN insures health, dental, vision, life and disability coverage for its employees, per Schedule A of its Form 5500. Its broker of record is STEPHEN HUNGATE. Coverage is written through BLUECROSS BLUESHIELD OF TENNESSEE, INC. and 3 other carriers. The plan's most recent policy period ended in April.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 95-3792594 · plan 501 · plan year 2025, filed Nov 15, 2025
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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
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 BLUECROSS BLUESHIELD OF TENNESSEE, INC., covers 260 people.
Reported premium across the insured contracts is $2,344,856, with $115,517 in disclosed broker commissions — about 4.9% of premium.
The most recent policy period ended in April, and the plan year ends April 30. Group contracts typically renew on that annual cycle.
STEPHEN HUNGATE is the broker of record on 1 of the 7 contracts; the rest name a different broker or none.
4 carriers appear on the filing, including BLUECROSS BLUESHIELD OF TENNESSEE, INC., KAISER FOUNDATION HEALTH PLAN, INC., UNITED OF OMAHA LIFE INSURANCE COMPANY and ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY. BLUECROSS BLUESHIELD OF TENNESSEE, INC. writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUECROSS BLUESHIELD OF TENNESSEE, INC. | Health, Dental, Vision | 260 | May 1, 2025 | $1,951,154 | $71,129 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life | 127 | May 1, 2025 | $98,688 | $14,803 |
| KAISER FOUNDATION HEALTH PLAN, INC. | Health | 27 | May 1, 2025 | $152,751 | $8,956 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Disability | 125 | May 1, 2025 | $59,479 | $8,922 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Disability | 152 | May 1, 2025 | $58,206 | $8,731 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life | 238 | May 1, 2025 | $10,663 | $1,599 |
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | Dental, Vision | 32 | May 1, 2025 | $13,915 | $1,377 |
Premium and claims on this contract
BLUECROSS BLUESHIELD OF TENNESSEE, INC., contract 141707. For the contract year on this filing, the carrier reported $1,951,154 in premium earned and $2,656,386 in claims incurred. Dividing one by the other gives 136%.
- BLUECROSS BLUESHIELD OF TENNESSEE, INC., contract 141707 reported $269,994 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: 251 employees, 6 recordable cases, 45 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
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