| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES INC | 15375 SE 30TH PL, #380 BELLEVUE, WA 98007 | REGENCE BLUECROSS BLUESHIELD OF OREGON | $23K | $7K | $30K | 4.65% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES INC | 15375 SE 30TH PL, #380 BELLEVUE, WA 98007 | LIFEMAP ASSURANCE COMPANY | $2K | $0 | $2K | 5.00% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES INC | 15375 SE 30TH PL, #380 BELLEVUE, WA 98007 | LIFEMAP ASSURANCE COMPANY | $377 | $0 | $377 | 5.00% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES INC | 15375 SE 30TH PL, #380 BELLEVUE, WA 98007 | LIFEMAP ASSURANCE COMPANY | $696 | $0 | $696 | 10.00% |
No Schedule C service providers reported on this filing.
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 | 410 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 412 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | REGENCE BLUECROSS BLUESHIELD OF OREGON | 483 | $650K |
| Dental(2 contracts, 2 carriers) | REGENCE BLUECROSS BLUESHIELD OF OREGON | 483 | $699K |
| Vision(2 contracts, 2 carriers) | REGENCE BLUECROSS BLUESHIELD OF OREGON | 483 | $658K |
| Life insurance | LIFEMAP ASSURANCE COMPANY | 291 | $7K |
| Prescription drug | REGENCE BLUECROSS BLUESHIELD OF OREGON | 483 | $650K |
| Other | LIFEMAP ASSURANCE COMPANY | 291 | $7K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 483 | — |
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."
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.