Form 5500 · Employee benefit plan · ELLSWORTH, ME
ELLSWORTH BUILDERS SUPPLY INC
The filing calls this plan EBS HEALTH PLAN.
Public Form 5500 records show how ELLSWORTH BUILDERS SUPPLY INC of ELLSWORTH, ME, a retail employer, structures its employee benefits. Its broker of record is CROSS BENEFIT SOLUTIONS. Coverage is written through HARVARD PILGRIM HEALTH CARE and 1 other carrier. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 01-0247727 · plan 501 · plan year 2024, filed Jul 31, 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
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 6 insured contracts are health coverage, split across HARVARD PILGRIM HEALTH CARE and HPHC INSURANCE COMPANY.
The filing declares health and vision. Vision appears 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 $1,083,612, with $31,119 in disclosed broker commissions — about 2.9% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
CROSS BENEFIT SOLUTIONS is the broker of record on all 6 contracts.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| HARVARD PILGRIM HEALTH CARE | Health | 141 | Jan 1, 2025 | $494,983 | $14,279 |
| HARVARD PILGRIM HEALTH CARE | Health | 126 | Jan 1, 2025 | $330,452 | $9,548 |
| HPHC INSURANCE COMPANY | Health | 74 | Jan 1, 2025 | $251,551 | $7,102 |
| HARVARD PILGRIM HEALTH CARE | Health | 1 | Jan 1, 2025 | $3,757 | $108 |
| HARVARD PILGRIM HEALTH CARE | Health | 1 | Jan 1, 2025 | $2,869 | $82 |
| HPHC INSURANCE COMPANY | Health | 0 | Jan 1, 2025 | — | $0 |
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: 16 employees, 1 recordable cases, 0 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
How this plan compares
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