Form 5500 · Employee benefit plan · SEATTLE, WA
COMMUNITY HOUSE MENTAL HEALTH AGENCY
The filing calls this plan COMMUNITY HOUSE MENTAL HEALTH AGENCY BENEFIT PLAN.
COMMUNITY HOUSE MENTAL HEALTH AGENCY of SEATTLE, WA is a 160-participant health care and social assistance employer whose group benefits are disclosed in its annual Form 5500 filing. Its broker of record is BROWN & BROWN INSURANCE SVCS. Coverage is written through DELTA DENTAL OF WASHINGTON and 2 other carriers. The plan's most recent policy period ended in May.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 91-0963226 · plan 501 · plan year 2026, filed Sep 24, 2026
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How this plan is funded
Funding not settled by the filing
The filing does not report enough to settle how this plan pays for benefits.
Benefits declared on this filing
One contract on this filing does not say which benefits it covers, so a line above may be insured by it.
Also declared: death benefits, other welfare.
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 3 insured contracts covering dental, vision, life and disability; the largest, with DELTA DENTAL OF WASHINGTON, covers 210 people.
The filing declares dental, vision, life, disability and health. Health appears with no insured contract on Schedule A. That coverage may be self-funded, placed with a carrier that is not on this filing, or written on the contract here that does not say what it covers.
Reported premium across the insured contracts is $178,466, with $11,507 in disclosed broker commissions — about 6.4% 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 SVCS is the broker of record on all 3 contracts.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| DELTA DENTAL OF WASHINGTON | Dental | 210 | Jun 1, 2026 | $133,439 | $6,751 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY | Vision, Life, Disability | 380 | Jun 1, 2026 | $39,965 | $3,997 |
| FIRST CHOICE HEALTH EAP | — | 215 | Jun 1, 2026 | $5,062 | $759 |
Premium and claims on this contract
DELTA DENTAL OF WASHINGTON, contract 12900. For the contract year on this filing, the carrier reported $133,439 in premium earned and $88,541 in claims incurred. Dividing one by the other gives 66%.
- DELTA DENTAL OF WASHINGTON, contract 12900 reported $23,752 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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