Form 5500 · Employee benefit plan · CANBY, OR
SHIMADZU USA MANUFACTURING INC.
The filing calls this plan SHIMADZU USA HEALTH AND WELFARE.
SHIMADZU USA MANUFACTURING INC. of CANBY, OR is a 165-participant manufacturing employer whose group benefits are disclosed in its annual Form 5500 filing. Its broker of record is KPD INSURANCE, INC.. Coverage is written through PROVIDENCE HEALTH PLAN and 3 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 52-1998212 · plan 501 · plan year 2025, filed Jun 23, 2026
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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 4 insured contracts covering health, dental, vision, life and disability; the largest, with PROVIDENCE HEALTH PLAN, covers 234 people.
Reported premium across the insured contracts is $1,531,622, with $51,672 in disclosed broker commissions — about 3.4% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
KPD INSURANCE, INC. is the broker of record on all 4 contracts.
4 carriers appear on the filing, including PROVIDENCE HEALTH PLAN, OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON, STANDARD INSURANCE COMPANY and EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO.. PROVIDENCE HEALTH PLAN writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| PROVIDENCE HEALTH PLAN | Health | 234 | Jan 1, 2026 | $1,327,644 | $39,829 |
| STANDARD INSURANCE COMPANY | Life, Disability | 145 | Jan 1, 2026 | $70,891 | $6,701 |
| OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | Dental | 246 | Jan 1, 2026 | $121,837 | $3,651 |
| EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | Vision | 178 | Jan 1, 2026 | $11,250 | $1,491 |
Premium and claims on this contract
STANDARD INSURANCE COMPANY, contract 170861. For the contract year on this filing, the carrier reported $70,891 in premium earned and $-2,434 in claims incurred. Dividing one by the other gives -3%.
- STANDARD INSURANCE COMPANY, contract 170861 reported $69,254 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.
Reported to OSHA
Reported to OSHA for 2025: 266 employees, 5 recordable cases, 5 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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