Plan Ledger DOL Form 5500 · updated monthly

Form Energy, Inc.benefits

Form Energy, Inc. Health and Welfare Benefit Plan · SOMERVILLE, MA · plan year 2025

Broker compensation reported · 2025
$365,188

Form Energy, Inc.'s benefits plans covered 894 active participants in 2025, providing health · life · dental · vision · short-term disability · long-term disability · death benefits. Insurance premiums totaled $11,266,284. Insurance brokers and agents were paid $365,188 in commissions and fees, costs that ultimately come out of what the employer and employees pay for coverage. That works out to 3.2% of premiums. That is $408 per covered person, above the median for employer plans that report broker pay. Broker pay fell 3.4% from $378,073 in 2024.

Insurance contracts · 20253
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. · health drug vision hmo ppo$11.3M · 1,537 covered
KAISER FOUNDATION HEALTH PLAN, INC. · health drug hmopremiums n/a · 168 covered
SUN LIFE ASSURANCE COMPANY OF CANADA · life std ltdpremiums n/a · 902 covered
Brokers & agents paid · 20252
JENNIFER A. BORISLOW INS AGENCY INC$299,643 · incl $61,120 fees
EMERSON ROGERS LLC$65,545 · incl $29,085 fees
Also brokered by Jennifer a. Borislow Ins Agency Inc5
Amego, Inc. MA$272,383

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Source: DOL Form 5500 Schedule A, plan year 2025, EIN 822266384 · Verify on EFAST2 · Amounts are as reported by the plan sponsor.