| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, INC | 15375 SE 30TH PLACE, SUITE 380 BELLEVUE, WA 98007 | REGENCE BLUESHIELD | $85K | $16K | $101K | 6.56% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, INC | 15375 SE 30TH PLACE, SUITE 380 BELLEVUE, WA 98007 | ASURIS NORTHWEST HEALTH | $8K | $3K | $10K | 4.82% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, INC | 15375 SE 30TH PLACE, SUITE 380 BELLEVUE, WA 98007 | DELTA DENTAL OF WASHINGTON | $5K | — | $5K | 4.03% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, INC | 15375 SE 30TH PLACE, SUITE 380 BELLEVUE, WA 98007 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC | $4K | — | $4K | 7.05% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, INC | 15375 SE 30TH PLACE, SUITE 380 BELLEVUE, WA 98007 | LIFEMAP ASSURANCE COMPANY | $2K | — | $2K | 8.77% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EPK & ASSOCIATES, INC EIN 91-1947441 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Plan Administrator; Direct payment from the plan Service code 14 | — | $94K |
| ANASTASI, MOORE & MARTIN, PLLC EIN 20-8149084 NONE | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $12K |
| EQUINOX BUSINESS LAW GROUP PLLC NONE | Legal; Direct payment from the plan Service code 29 | 11130 NE 33RD PL BELLEVUE, WA 98004 | $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 | 701 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 705 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | REGENCE BLUESHIELD | 3,344 | $1.8M |
| Dental | DELTA DENTAL OF WASHINGTON | 507 | $134K |
| Vision(3 contracts, 3 carriers) | REGENCE BLUESHIELD | 3,344 | $1.8M |
| Life insurance | LIFEMAP ASSURANCE COMPANY | 1,590 | $26K |
| Short-term disability | LIFEMAP ASSURANCE COMPANY | 1,590 | $26K |
| Prescription drug(3 contracts, 3 carriers) | REGENCE BLUESHIELD | 3,344 | $1.8M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,344 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.