Form 5500 · Employee benefit plan · BROCKTON, MA
OLD COLONY ELDER SERVICES
The filing calls this plan OLD COLONY ELDER SERVICES HEALTH AND WELFARE BENEFITS PLAN.
OLD COLONY ELDER SERVICES of BROCKTON, MA files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is BROWN & BROWN INSURANCE SVS, INC. Coverage is written through BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. and 2 other carriers. The plan's most recent policy period ended in May.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 04-2545236 · plan 501 · plan year 2025, filed Nov 7, 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: 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.
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 5 insured contracts covering health, dental, vision, life and disability; the largest, with BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC., covers 150 people.
Reported premium across the insured contracts is $3,123,078, with $84,384 in disclosed broker commissions — about 2.7% of premium.
The most recent policy period ended in May, and the plan year ends May 31. Group contracts typically renew on that annual cycle.
BROWN & BROWN INSURANCE SVS, INC is the broker of record on 3 of the 5 contracts; the rest name a different broker or none.
3 carriers appear on the filing, including BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC., THE LINCOLN NATIONAL LIFE INSURANCE COMPANY and EYEMED VISION CARE. 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 | 150 | Jun 1, 2025 | $2,862,896 | $70,701 |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | Dental | 189 | Jun 1, 2025 | $152,586 | $5,319 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | Disability | 230 | Jun 1, 2025 | $35,102 | $3,796 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | Life | 230 | Jun 1, 2025 | $55,345 | $2,990 |
| EYEMED VISION CARE | Vision | 131 | Jun 1, 2025 | $17,149 | $1,578 |
Premium and claims on these contracts
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC., contract 4959122. For the contract year on this filing, the carrier reported $2,862,896 in premium earned and $2,707,897 in claims incurred. Dividing one by the other gives 95%.
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC., contract 4959122. For the contract year on this filing, the carrier reported $152,586 in premium earned and $132,993 in claims incurred. Dividing one by the other gives 87%.
- BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC., contract 4959122 reported $105,337 in retention.
- BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC., contract 4959122 reported $16,933 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.
How this plan compares
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