Form 5500 · Employee benefit plan · AVON, NY
DP TOOL & MACHINE, INC.
The filing calls this plan DP TOOL & MACHINE, INC. EMPLOYEE BENEFITS PLAN.
DP TOOL & MACHINE, INC. of AVON, NY spreads its employee benefits across 3 insurance carriers, according to its Form 5500 Schedule A. Its broker of record is BROWN & BROWN INS SVCS INC. Coverage is written through EXCELLUS BLUE CROSS BLUE SHIELD and 2 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 16-6153350 · plan 501 · plan year 2024, filed Jun 4, 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.
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 EXCELLUS BLUE CROSS BLUE SHIELD, covers 69 people.
Reported premium across the insured contracts is $694,288, with $37,759 in disclosed broker commissions — about 5.4% of premium.
The health contract's policy period ended in December, while at least one ancillary line's policy period ended in October. The plan is on a split renewal cycle.
BROWN & BROWN INS SVCS INC is the broker of record on 1 of the 4 contracts; the rest name a different broker or none.
3 carriers appear on the filing, including EXCELLUS BLUE CROSS BLUE SHIELD, SUN LIFE AND HEALTH INSURANCE COMPANY and VISION SERVICE PLAN. EXCELLUS BLUE CROSS BLUE SHIELD writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| EXCELLUS BLUE CROSS BLUE SHIELD | Health | 69 | Jan 1, 2025 | $550,484 | $24,439 |
| SUN LIFE AND HEALTH INSURANCE COMPANY | Life, Disability | 102 | Nov 1, 2024 | $68,594 | $7,250 |
| EXCELLUS BLUE CROSS BLUE SHIELD | Dental | 52 | Jan 1, 2025 | $36,358 | $3,913 |
| VISION SERVICE PLAN | Vision | 363 | Jan 1, 2025 | $38,852 | $2,157 |
Premium and claims on these contracts
EXCELLUS BLUE CROSS BLUE SHIELD, contract 00055332. For the contract year on this filing, the carrier reported $36,358 in premium earned and $26,548 in claims incurred. Dividing one by the other gives 73%.
VISION SERVICE PLAN, contract 30037380. For the contract year on this filing, the carrier reported $38,852 in premium earned and $20,057 in claims incurred. Dividing one by the other gives 52%.
- EXCELLUS BLUE CROSS BLUE SHIELD, contract 00055332 reported $11,500 in retention.
- VISION SERVICE PLAN, contract 30037380 reported $7,770 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: 106 employees, 5 recordable cases, 26 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
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