Plan Ledger DOL Form 5500 · updated monthly

Polyfoam LLCbenefits

Polyfoam LLC Health and Welfare Plan · NORTHBRIDGE, MA · plan year 2023

Broker compensation reported · 2023
$9,978

Polyfoam LLC's benefits plan covered 0 active participants in 2023, providing health · life · dental · vision · long-term disability · death benefits. Insurance brokers and agents were paid $9,978 in commissions and fees, costs that ultimately come out of what the employer and employees pay for coverage.

Insurance contracts · 20233
BLUE CROSS BLUE SHIELD MASSACHUSETTS, INC. · health dental hmo ppopremiums n/a · 92 covered
VISION SERVICE PLAN · visionpremiums n/a · 30 covered
USABLE LIFE · life ltdpremiums n/a · 109 covered
Brokers & agents paid · 20232
LOCKTON COMPANIES, LLC$8,103 · incl $3,480 fees
Also brokered by Lockton5
Banner Health AZ$2,557,307

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Source: DOL Form 5500 Schedule A, plan year 2023, EIN 845102726 · Verify on EFAST2 · Amounts are as reported by the plan sponsor.