| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFITS SERVICES INC. | 15375 SE 30TH PL, SUITE 380 BELLEVUE, WA 980076500 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 9.82% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFITS SERVICES INC. | 15375 SE 30TH PL, SUITE 380 BELLEVUE, WA 980076500 | LIFEMAP ASSURANCE COMPANY | $3K | — | $3K | 6.99% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFITS SERVICES INC. | 15375 SE 30TH PL, SUITE 380 BELLEVUE, WA 980076500 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $4K | — | $4K | 10.00% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFITS SERVICES INC. | 15375 SE 30TH PL, SUITE 380 BELLEVUE, WA 980076500 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $728 | — | $728 | 10.00% |
No Schedule C service providers reported on this filing.
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 | 265 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 265 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts, 2 carriers) | LIFEMAP ASSURANCE COMPANY | 265 | $77K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 217 | $42K |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 209 | $7K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 265 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.