| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL SUITE 380 BELLEVUE, WA 98007 | REGENCE BLUESHIELD | $549K | $181K | $730K | 6.37% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL SUITE 380 BELLEVUE, WA 98007 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | $146K | — | $146K | 8.15% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL SUITE 380 BELLEVUE, WA 98007 | DELTA DENTAL OF WASHINGTON | $63K | — | $63K | 7.00% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL SUITE 380 BELLEVUE, WA 98007 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON | $38K | — | $38K | 7.71% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL SUITE 380 BELLEVUE, WA 98007 | LIFEMAP ASSURANCE COMPANY | $12K | — | $12K | 9.48% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL SUITE 380 BELLEVUE, WA 98007 | ASURIS NORTHWEST HEALTH | $3K | $2K | $5K | 8.31% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EPK & ASSOCIATES, INC. EIN 91-1947441 PLAN ADMINISTRATOR | Direct payment from the plan; Plan Administrator Service code 14 | — | $273K |
| FIRST CHOICE HEALTH EIN 91-1272766 EMPLOYEE ASSISTANCE | Other services; Direct payment from the plan Service code 49 | — | $26K |
| SWEENEY CONRAD, P.S. EIN 91-1301672 ACCOUNTANT | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $16K |
| TRAVELERS INDEMNITY COMPANY EIN 06-0566050 INSURER | Insurance agents and brokers; Direct payment from the plan Service code 22 | — | $10K |
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 1,731 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 11 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,742 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | REGENCE BLUESHIELD | 1,818 | $13.8M |
| Dental | DELTA DENTAL OF WASHINGTON | 1,783 | $907K |
| Vision(3 contracts, 3 carriers) | REGENCE BLUESHIELD | 1,948 | $11.6M |
| Life insurance | LIFEMAP ASSURANCE COMPANY | 1,948 | $129K |
| Prescription drug(4 contracts, 4 carriers) | REGENCE BLUESHIELD | 1,818 | $13.8M |
| Other | LIFEMAP ASSURANCE COMPANY | 1,948 | $129K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,948 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.