| 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 BLUESHIELD | $758K | $343K | $1.1M | 8.03% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL SUITE 380 BELLEVUE, WA 98007 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | $106K | — | $106K | 7.58% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL SUITE 380 BELLEVUE, WA 98007 | DELTA DENTAL OF WASHINGTON | $86K | — | $86K | 7.00% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL SUITE 380 BELLEVUE, WA 98007 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON | $49K | — | $49K | 8.18% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL SUITE 380 BELLEVUE, WA 98007 | ASURIS NORTHWEST HEALTH | $28K | $5K | $33K | 6.84% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL SUITE 380 BELLEVUE, WA 98007 | LIFEMAP ASSURANCE COMPANY | $14K | — | $14K | 10.19% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL SUITE 380 BELLEVUE, WA 98007 | LIFEMAP ASSURANCE COMPANY | $6K | — | $6K | 8.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EPK & ASSOCIATES, INC. EIN 91-1947441 PLAN ADMINISTRATOR | Plan Administrator; Direct payment from the plan Service code 14 | — | $401K |
| FIRST CHOICE HEALTH EIN 91-1272766 EMPLOYEE ASSISTANCE | Other services; Direct payment from the plan Service code 49 | — | $39K |
| JOHN S. CONNIFF, PLLC EIN 20-3527112 LAWYER | Legal; Direct payment from the plan Service code 29 | — | $24K |
| SWEENEY CONRAD, P.S. EIN 91-1301672 ACCOUNTANT | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $16K |
| AHT INSURANCE INSURER | Insurance agents and brokers; Direct payment from the plan Service code 22 | 20 SOUTH KING ST LEESBURG, VA 20175 | $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 | 2,231 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 16 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 2,247 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | REGENCE BLUESHIELD | 2,500 | $16.2M |
| Dental | DELTA DENTAL OF WASHINGTON | 2,431 | $1.2M |
| Vision(3 contracts, 3 carriers) | REGENCE BLUESHIELD | 2,500 | $14.3M |
| Life insurance | LIFEMAP ASSURANCE COMPANY | 2,640 | $142K |
| Prescription drug(4 contracts, 4 carriers) | REGENCE BLUESHIELD | 2,500 | $16.2M |
| Other | LIFEMAP ASSURANCE COMPANY | 2,640 | $142K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,640 | — |
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.