Form 5500 · Employee benefit plan · SEATTLE, WA
SEATTLE ROOTS COMMUNITY HEALTH
The filing calls this plan SEATTLE ROOTS COMMUNITY HEALTH WELFARE BENEFITS PLAN.
SEATTLE ROOTS COMMUNITY HEALTH of SEATTLE, WA is a 199-participant health care and social assistance employer whose group benefits are disclosed in its annual Form 5500 filing. Its broker of record is USI INSURANCE SERVICES, LLC. Coverage is written through KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. and 6 other carriers. The plan's most recent policy period ended in August.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 23-7100868 · plan 501 · plan year 2025, filed Apr 23, 2026
Get an email when this employer files a new Form 5500, and again about four months before its plan renews.
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, 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 7 insured contracts covering health, dental, vision, life and disability; the largest, with KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC., covers 118 people.
Reported premium across the insured contracts is $2,607,891, with $98,359 in disclosed broker commissions — about 3.8% of premium.
The health contract's policy period ended in August, while at least one ancillary line's policy period ended in November. The plan is on a split renewal cycle.
USI INSURANCE SERVICES, LLC is the broker of record on 5 of the 7 contracts; the rest name a different broker or none.
7 carriers appear on the filing, including KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC., KAISER FOUNDATION HEALTH PLAN OF WASHINGTON, DELTA DENTAL OF WASHINGTON and SYMETRA LIFE INSURANCE COMPANY. KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | Health | 118 | Sep 1, 2025 | $1,351,695 | $37,223 |
| KAISER FOUNDATION HEALTH PLAN OF WASHINGTON | Health | 98 | Sep 1, 2025 | $969,327 | $26,591 |
| SYMETRA LIFE INSURANCE COMPANY | Life, Disability | 207 | Sep 1, 2025 | $88,016 | $21,620 |
| DELTA DENTAL OF WASHINGTON | Dental, Vision | 179 | Sep 1, 2025 | $138,427 | $8,360 |
| WILLAMETTE DENTAL OF WASHINGTON, INC. | Dental | 77 | Sep 1, 2025 | $52,665 | $4,565 |
| CURALINC LLC | — | 199 | Sep 1, 2025 | $5,821 | $0 |
| WELLSPRING FAMILY SERVICES EAP | — | 199 | Dec 1, 2024 | $1,940 | $0 |
Premium and claims on these contracts
DELTA DENTAL OF WASHINGTON, contract 3831. For the contract year on this filing, the carrier reported $138,427 in premium earned and $100,032 in claims incurred. Dividing one by the other gives 72%.
WILLAMETTE DENTAL OF WASHINGTON, INC., contract WA259. For the contract year on this filing, the carrier reported $52,665 in premium earned and $34,697 in claims incurred. Dividing one by the other gives 66%.
- DELTA DENTAL OF WASHINGTON, contract 3831 reported $21,872 in retention.
- WILLAMETTE DENTAL OF WASHINGTON, INC., contract WA259 reported $11,280 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
Subscribers see how this compares with similar plans in Washington. A subscription also adds this plan's filing history and the renewal calendar for its state. See plans and prices
Without an account you can open 10 employer, broker and carrier pages a day, including through an AI assistant, and 50 a day with a free account. Paid plans are what keep these records free to read.
More employer plans in Washington — largest plans, brokers, carriers and renewal months.