Form 5500 · Employee benefit plan · MASHPEE, MA
SOUTHWORTH DEVELOPMENT LLC
The filing calls this plan SOUTHWORTH DEVELOPMENT HEALTH AND WELFARE PLAN.
SOUTHWORTH DEVELOPMENT LLC of MASHPEE, MA files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is USI INSURANCE SERVICES LLC. Coverage is written through BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. and 1 other carrier. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 20-2759238 · plan 501 · plan year 2025, filed May 21, 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.
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 2 insured contracts covering health, dental, vision, life and disability; the largest, with BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC., covers 216 people.
Reported premium across the insured contracts is $2,453,199, with $55,850 in disclosed broker commissions — about 2.3% 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.
USI INSURANCE SERVICES LLC is the broker of record on all 2 contracts.
Two carriers split the book: BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. and THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. | Health | 216 | Jan 1, 2026 | $2,243,092 | $37,618 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | Health, Dental, Vision, Life, Disability | 238 | Jan 1, 2026 | $210,107 | $18,232 |
Premium and claims on this contract
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC., contract 4960737. For the contract year on this filing, the carrier reported $2,243,092 in premium earned and $1,900,597 in claims incurred. Dividing one by the other gives 85%.
- BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC., contract 4960737 reported $342,494 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.
Other plans filed by this employer
How this plan compares
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