| 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 BLUECROSS BLUESHIELD OF OREGON | $517K | — | $517K | 4.38% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL SUITE 380 BELLEVUE, WA 98007 | LIFEMAP ASSURANCE COMPANY | $40K | — | $40K | 5.76% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EPK & ASSOCIATES, INC. EIN 91-1947441 PLAN ADMINISTRATOR | Direct payment from the plan; Plan Administrator Service code 14 | — | $363K |
| CAPITAL BENEFIT SERVICES, LLC EIN 91-1619527 START-UP ASSISTANCE | Contract Administrator; Direct payment from the plan; Accounting (including auditing); Insurance agents and brokers; Insurance services Service code 10 | — | $323K |
| SWEENEY CONRAD, P.S. EIN 91-1301672 ACCOUNTANT | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $14K |
| FIRST CHOICE HEALTH EIN 91-1272766 EMPLOYEE ASSISTANCE | Other services; Direct payment from the plan Service code 49 | — | $10K |
| CHUBB INSURANCE COMPANY EIN 13-2595722 INSURANCE AGENT | Direct payment from the plan; Insurance agents and brokers Service code 22 | — | $6K |
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 | 1,715 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,724 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | REGENCE BLUECROSS BLUESHIELD OF OREGON | 2,728 | $11.8M |
| Dental | LIFEMAP ASSURANCE COMPANY | 1,769 | $696K |
| Vision | LIFEMAP ASSURANCE COMPANY | 1,769 | $696K |
| Life insurance | LIFEMAP ASSURANCE COMPANY | 1,769 | $696K |
| Prescription drug | REGENCE BLUECROSS BLUESHIELD OF OREGON | 2,728 | $11.8M |
| Other | LIFEMAP ASSURANCE COMPANY | 1,769 | $696K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,728 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
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.