| 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 | REGENCE BLUECROSS BLUESHIELD OF OREGON | $5K | — | $5K | 0.24% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL STE 380 BELLEVUE, WA 98007 | USABLE LIFE | $2K | — | $2K | 9.83% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL STE 380 BELLEVUE, WA 98007 | USABLE LIFE | $160 | — | $160 | 7.92% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CAPITAL BENEFIT SERVICES, LLC EIN 91-1619527 INSURANCE AGENT / BROKER | Insurance agents and brokers; Contract Administrator; Direct payment from the plan Service code 13 | — | $149K |
| EPK & ASSOCIATES, INC. EIN 91-1947441 PLAN ADMINISTRATOR | Plan Administrator; Direct payment from the plan Service code 14 | — | $62K |
| L/P INSURANCE SERVICES LLC INSURANCE AGENT | Insurance agents and brokers; Direct payment from the plan Service code 22 | 300 EAST 2ND ST SUITE 1300 RENO, NV 89501 | $5K |
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 | 1,578 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 15 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,593 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | REGENCE BLUECROSS BLUESHIELD OF OREGON | 2,596 | $2.3M |
| Dental | REGENCE BLUECROSS BLUESHIELD OF OREGON | 2,596 | $2.3M |
| Vision | REGENCE BLUECROSS BLUESHIELD OF OREGON | 2,596 | $2.3M |
| Life insurance(2 contracts) | USABLE LIFE | 1,613 | $20K |
| Prescription drug | REGENCE BLUECROSS BLUESHIELD OF OREGON | 2,596 | $2.3M |
| Other | USABLE LIFE | 1,613 | $18K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,596 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.