| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL STE 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 STE 380 BELLEVUE, WA 98007 | REGENCE BLUESHIELD | $11K | — | $11K | 8.16% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL STE 380 BELLEVUE, WA 98007 | DELTA DENTAL OF WASHINGTON | $8K | — | $8K | 7.94% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL STE 380 BELLEVUE, WA 98007 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $14K | — | $14K | 15.00% |
| ASSUREDPARTNERS3 Filed as: EMERSON ROGERS LLC | 669 RIVER DR CENTER II STE 305 ELMWOOD PARK, NJ 07407 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $6K | $6K | 6.10% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL STE 380 BELLEVUE, WA 98007 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $6K | — | $6K | 15.00% |
| ASSUREDPARTNERS3 Filed as: EMERSON ROGERS LLC | 669 RIVER DR CENTER II STE 305 ELMWOOD PARK, NJ 07407 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $2K | $2K | 5.64% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL STE 380 BELLEVUE, WA 98007 | ASURIS NORTHWEST HEALTH | $6 | — | $6 | 50.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CAPITAL BENEFIT SERVICES, LLC EIN 91-1619527 INSURANCE AGENT/BROKER | Insurance agents and brokers; Direct payment from the plan Service code 22 | — | $825K |
| EPK & ASSOCIATES, INC. EIN 91-1947441 PLAN ADMINISTRATOR | Direct payment from the plan; Plan Administrator Service code 14 | — | $265K |
| 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 | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $17K |
| TRAVELERS INDEMNITY COMPANY EIN 06-0566050 INSURANCE AGENT | Insurance agents and brokers; Direct payment from the plan Service code 22 | — | $9K |
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 | 1,665 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,674 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 5 carriers) | PREMERA BLUE CROSS | 1,844 | $12.6M |
| Dental | DELTA DENTAL OF WASHINGTON | 1,773 | $895K |
| Vision(3 contracts, 3 carriers) | REGENCE BLUESHIELD | 1,365 | $238K |
| Life insurance(2 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 1,729 | $136K |
| Prescription drug(5 contracts, 5 carriers) | PREMERA BLUE CROSS | 1,844 | $12.6M |
| Other | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 1,729 | $96K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,844 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.