Form 5500 · Employee benefit plan · SEATTLE, WA
DAVIS DOOR SERVICE, INC.
The filing calls this plan DAVIS DOOR SERVICE, INC. BENEFIT PLAN.
DAVIS DOOR SERVICE, INC. of SEATTLE, WA is a 108-participant construction employer whose group benefits are disclosed in its annual Form 5500 filing. Its broker of record is HUB INTERNATIONAL NORTHWEST LLC. Coverage is written through REGENCE BLUESHIELD and 2 other carriers. The plan's most recent policy period ended in June.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 91-1159999 · plan 501 · plan year 2025, filed Oct 22, 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 3 insured contracts covering health, dental, vision, life and disability; the largest, with REGENCE BLUESHIELD, covers 168 people.
Reported premium across the insured contracts is $1,279,157, with $61,705 in disclosed broker commissions — about 4.8% of premium.
The most recent policy period ended in June, and the plan year ends June 30. Group contracts typically renew on that annual cycle.
HUB INTERNATIONAL NORTHWEST LLC is the broker of record on all 3 contracts.
3 carriers appear on the filing, including REGENCE BLUESHIELD, DELTA DENTAL OF WASHINGTON and THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA. REGENCE BLUESHIELD writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| REGENCE BLUESHIELD | Health, Vision | 168 | Jul 1, 2025 | $1,140,163 | $52,304 |
| DELTA DENTAL OF WASHINGTON | Dental | 188 | Jul 1, 2025 | $106,080 | $5,270 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | Life, Disability | 106 | Jul 1, 2025 | $32,914 | $4,131 |
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.
Reported to OSHA
Reported to OSHA for 2025: 111 employees, 7 recordable cases, 16 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
How this plan compares
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