| 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 | $471K | $236K | $707K | 7.48% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, INC | 15375 SE 30TH PLACE, SUITE 380 BELLEVUE, WA 98007 | DELTA DENTAL OF WASHINGTON | $62K | — | $62K | 7.53% |
| 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 | $47K | — | $47K | 8.19% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, INC | 15375 SE 30TH PLACE, SUITE 380 BELLEVUE, WA 98007 | ASURIS NORTHWEST HEALTH | $13K | $2K | $15K | 5.81% |
| 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, INC | $18K | — | $18K | 8.58% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, INC | 15375 SE 30TH PLACE, SUITE 380 BELLEVUE, WA 98007 | LIFEMAP ASSURANCE COMPANY | $12K | — | $12K | 11.11% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, INC | 15375 SE 30TH PLACE, SUITE 380 BELLEVUE, WA 98007 | LIFEMAP ASSURANCE COMPANY | $5K | — | $5K | 5.13% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CENTER FOR ADVANCED MANUFACTURING TRUSTOR | Other fees; Other services; Direct payment from the plan Service code 49 | 6915 S 234TH ST KENT, WA 98032 | $303K |
| EPK AND ASSOCIATES, INC EIN 91-1947441 NONE | Plan Administrator; Accounting (including auditing); Recordkeeping and information management (computing, tabulating, data processing, etc.); Direct payment from the plan Service code 10 | — | $290K |
| JOHN S. CONNIFF, PLLC NONE | Legal; Direct payment from the plan Service code 29 | P.O. BOX 7933 TACOMA, WA 984170933 | $22K |
| ANASTASI, MOORE & MARTIN, PLLC EIN 20-8149084 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $12K |
| FIRST CHOICE HEALTH EIN 91-1272766 NONE | Other services; Direct payment from the plan Service code 49 | — | $8K |
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 | 1,762 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 27 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,789 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | REGENCE BLUESHIELD | 1,621 | $10.5M |
| Dental | DELTA DENTAL OF WASHINGTON | 1,207 | $823K |
| Vision(3 contracts, 3 carriers) | REGENCE BLUESHIELD | 1,621 | $9.8M |
| Life insurance | LIFEMAP ASSURANCE COMPANY | 1,689 | $106K |
| Prescription drug(4 contracts, 4 carriers) | REGENCE BLUESHIELD | 1,621 | $10.5M |
| Other | LIFEMAP ASSURANCE COMPANY | 1,689 | $106K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,689 | — |
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.