Form 5500 · Employee benefit plan · MCCLEARY, WA
SIMPSON DOOR
The filing calls this plan SIMPSON DOOR COMPANY HEALTH & WELFARE BENEFIT PLAN.
Public Form 5500 records show how SIMPSON DOOR of MCCLEARY, WA, a manufacturing employer, structures its employee benefits. Its broker of record is WOODRUFF-SAWYER & CO. Coverage is written through PREMERA BLUE CROSS and 4 other carriers. The plan's most recent policy period ended in June.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 91-1940130 · plan 501 · plan year 2025, filed Jan 22, 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: 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 PREMERA BLUE CROSS, covers 123 people.
Reported premium across the insured contracts is $1,373,482, with $52,194 in disclosed broker commissions — about 3.8% 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.
WOODRUFF-SAWYER & CO is the broker of record on 1 of the 7 contracts; the rest name a different broker or none.
5 carriers appear on the filing, including PREMERA BLUE CROSS, DELTA DENTAL OF WASHINGTON, UNITED OF OMAHA LIFE INSURANCE COMPANY and VISION SERVICE PLAN. PREMERA BLUE CROSS writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| PREMERA BLUE CROSS | Health | 123 | Jul 1, 2025 | $1,221,086 | $40,085 |
| DELTA DENTAL OF WASHINGTON | Dental | 147 | Jul 1, 2025 | $90,992 | $4,552 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life | 86 | Jul 1, 2025 | $22,196 | $3,329 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Disability | 86 | Jul 1, 2025 | $14,462 | $2,169 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life | 42 | Jul 1, 2025 | $8,717 | $1,308 |
| VISION SERVICE PLAN | Vision | 80 | Jul 1, 2025 | $10,014 | $751 |
| EMPATHIA, INC. | — | 246 | Jul 1, 2025 | $6,015 | $0 |
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.
Reported to OSHA
Reported to OSHA for 2025: 238 employees, 17 recordable cases, 256 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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