| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL STE 380 BELLEVUE, WA 98007 | REGENCE BLUESHIELD | $17K | — | $17K | 0.14% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL STE 380 BELLEVUE, WA 98007 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | $5K | — | $5K | 0.23% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL STE 380 BELLEVUE, WA 98007 | DELTA DENTAL OF WASHINGTON | $76K | — | $76K | 7.02% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL STE 380 BELLEVUE, WA 98007 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON | $618 | — | $618 | 0.09% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL STE 380 BELLEVUE, WA 98007 | ASURIS NORTHWEST HEALTH | $303 | — | $303 | 0.05% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL STE 380 BELLEVUE, WA 98007 | DELTA DENTAL OF WASHINGTON | $12K | — | $12K | 7.86% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL STE 380 BELLEVUE, WA 98007 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $18K | — | $18K | 15.00% |
| ASSUREDPARTNERS3 Filed as: EMERSON ROGERS LLC | 669 RIVER DR CENTER II STE 305 ELMWOOD PARK, NJ 07407 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $9K | $9K | 7.07% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL STE 380 BELLEVUE, WA 98007 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $5K | — | $5K | 15.00% |
| ASSUREDPARTNERS3 Filed as: EMERSON ROGERS LLC | 669 RIVER DR CENTER II STE 305 ELMWOOD PARK, NJ 07407 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $2K | $2K | 6.74% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CAPITAL BENEFIT SERVICES, LLC EIN 91-1619527 INSURANCE AGENT/BROKER | Other services; Insurance agents and brokers; Direct payment from the plan Service code 22 | — | $1.1M |
| EPK & ASSOCIATES, INC. EIN 91-1947441 PLAN ADMINISTRATOR | Direct payment from the plan; Plan Administrator Service code 14 | — | $396K |
| 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 | — | $23K |
| L/P INSURANCE SERVICES LLC INSURANCE AGENT | Direct payment from the plan; Insurance agents and brokers Service code 22 | 300 EAST 2ND ST SUITE 1300 RENO, NV 89501 | $12K |
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 | 2,306 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 14 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 2,320 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | REGENCE BLUESHIELD | 2,318 | $15.1M |
| Dental | DELTA DENTAL OF WASHINGTON | 2,280 | $1.1M |
| Vision(3 contracts, 3 carriers) | REGENCE BLUESHIELD | 2,318 | $12.5M |
| Life insurance(2 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 2,249 | $152K |
| Prescription drug(4 contracts, 4 carriers) | REGENCE BLUESHIELD | 2,318 | $15.1M |
| Other | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 2,249 | $121K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,318 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Multiple-employer welfare arrangement. Specific regulatory and compliance context; specific consultant niche.