Form 5500 · Employee benefit plan · ROWLEY, MA
IPSWICH BAY GLASS COMPANY, INC.
The filing calls this plan IPSWICH BAY GLASS COMPANY, INC. HEALTH AND WELFARE PLAN.
IPSWICH BAY GLASS COMPANY, INC. of ROWLEY, MA is a 87-participant construction employer whose group benefits are disclosed in its annual Form 5500 filing. Its broker of record is USI INSURANCE SERVICE LLC. Coverage is written through TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION, INC. and 2 other carriers. The plan's most recent policy period ended in March.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 04-2538458 · plan 501 · plan year 2025, filed Jun 24, 2026
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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.
The filing carries code 4S: this plan is filing again after previously being exempt.
Benefits declared on this filing
Also declared: death benefits.
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 3 insured contracts covering health, dental, life and disability; the largest, with TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION, INC., covers 118 people.
Reported premium across the insured contracts is $1,035,371, with $25,980 in disclosed broker commissions — about 2.5% of premium.
The most recent policy period ended in March, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
USI INSURANCE SERVICE LLC is the broker of record on 2 of the 3 contracts; the rest name a different broker or none.
3 carriers appear on the filing, including TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION, INC., THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA and TUFTS INSURANCE COMPANY. TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION, INC. writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION, INC. | Health | 118 | Apr 1, 2025 | $891,773 | $21,888 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | Dental, Life, Disability | 51 | Apr 1, 2025 | $75,283 | $3,036 |
| TUFTS INSURANCE COMPANY | Health | 10 | Apr 1, 2025 | $68,315 | $1,056 |
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: 65 employees, 3 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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