Form 5500 · Employee benefit plan · BOTHELL, WA
NORTHWEST LABORERS-EMPLOYERS HEALTH & SE BOARD OF TRUSTEES
The filing calls this plan NW LABORERS-EMPLOYERS H & S TRUST FUND.
NORTHWEST LABORERS-EMPLOYERS HEALTH & SE BOARD OF TRUSTEES of BOTHELL, WA spreads its employee benefits across 3 insurance carriers, according to its Form 5500 Schedule A. Coverage is written through DELTA DENTAL OF WASHINGTON and 2 other carriers. The plan's most recent policy period ended in March.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 91-1283260 · plan 501 · plan year 2025, filed Jan 14, 2026
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How this plan is funded
Self-funded as reported
The filing reports benefits paid from the plan's own money, and no medical insurance contract on Schedule A.
A stop-loss policy appears on a Form 5500 only when the plan itself is the beneficiary, or the premiums are paid from plan money. Many employers buy stop-loss and never report it here. So a plan with no stop-loss on its filing may still have it.
Benefits declared on this filing
Also declared: 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.
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 3 insured contracts covering dental and vision; the largest, with DELTA DENTAL OF WASHINGTON, covers 15,204 people.
The filing declares dental, vision, health, life and disability. Health, life and disability appear with no insured contract on Schedule A. That coverage may be self-funded, or placed with a carrier that is not on this filing.
Reported premium is $8,915,706; the filing discloses no broker commission on these contracts.
The most recent policy period ended in March, and the plan year ends March 31. Group contracts typically renew on that annual cycle.
No broker of record is named on the Schedule A. The contracts may be written directly with the carrier, or the broker fields were left blank on the filing.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| DELTA DENTAL OF WASHINGTON | Dental | 15,204 | Apr 1, 2025 | $6,573,511 | $0 |
| WILLAMETTE DENTAL OF WASHINGTON, INC. | Dental | 3,973 | Apr 1, 2025 | $1,648,482 | $0 |
| VISION SERVICE PLAN | Vision | 7,583 | Apr 1, 2025 | $693,713 | $0 |
Premium and claims on these contracts
DELTA DENTAL OF WASHINGTON, contract 03839. For the contract year on this filing, the carrier reported $6,573,511 in premium earned and $6,157,765 in claims incurred. Dividing one by the other gives 94%.
WILLAMETTE DENTAL OF WASHINGTON, INC., contract WA132. For the contract year on this filing, the carrier reported $1,648,482 in premium earned and $1,565,036 in claims incurred. Dividing one by the other gives 95%.
VISION SERVICE PLAN, contract 12319269. For the contract year on this filing, the carrier reported $693,713 in premium earned and $597,504 in claims incurred. Dividing one by the other gives 86%.
- DELTA DENTAL OF WASHINGTON, contract 03839 reported $386,909 in retention.
- WILLAMETTE DENTAL OF WASHINGTON, INC., contract WA132 reported $152,484 in retention.
- VISION SERVICE PLAN, contract 12319269 reported $96,209 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. The service providers are named on Schedule C of this filing. We publish company names only.
Money the plan held and paid out
Sourced from U.S. DOL EFAST2 Form 5500 · Schedule H
These are the plan's own figures from Schedule H, the financial statement it files. They are not the premium on Schedule A.
How this plan compares
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