| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ANTONIO JOSE ANGELES3 Filed as: ANTONIO MICHAEL JAIME | 24345 252ND AVE SE MAPLE VALLEY, WA 98038 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $18K | $4K | $22K | 9.58% |
| RICH IN BENEFITS INC3 | 13109 NE 123RD ST KIRKLAND, WA 98034 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12K | $4K | $15K | 6.60% |
| DOUGLAS-MCCARTY INSURANCE SERVICES3 Filed as: DOUGLAS EDWARD VIESELMEYER | 14405 115TH AVE CT E PUYALLUP, WA 98374 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $1K | $4K | 1.77% |
| ROBERT WILLIAM PLATTE3 | 15221 227TH AVE NE WOODINVILLE, WA 98077 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $176 | $4K | 1.72% |
| MEGAN ELIZABETH CASTO3 | HOME OFFICE COLUMBIA, SC 29202 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $606 | $389 | $995 | 0.43% |
| RONALD JONES3 | 320 NANCY CT MOSCOW, ID 83843 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $928 | — | $928 | 0.40% |
| DANIEL SHARP3 | 1911 98TH ST SE EVERETT, WA 98208 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $90 | $258 | $348 | 0.15% |
| SUSAN LYNNE JOHNSON3 | PO BOX 65962 TACOMA, WA 98464 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | $68 | $78 | 0.03% |
| GIULIANA F MORA3 | 12800 NE 4TH ST VANCOUVER, WA 98684 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $10 | $15 | $25 | 0.01% |
| HEATHER MARIE JONES3 | 6325 E 18TH AVE SPOKANE VALLEY, WA 99212 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $19 | — | $19 | 0.01% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES INC | 15375 SE 30TH PL, #380 BELLEVUE, WA 98007 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | — | $5K | 10.56% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES INC | 15375 SE 30TH PL #380 BELLEVUE, WA 98007 | LIFEMAP ASSURANCE COMPANY | $3K | — | $3K | 6.67% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES INC | 15375 SE 30TH PL, #380 BELLEVUE, WA 98007 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 10.00% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES INC | 15375 SE 30TH PL, #380 BELLEVUE, WA 98007 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $448 | — | $448 | 9.99% |
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 | 294 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 294 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance(2 contracts, 2 carriers) | LIFEMAP ASSURANCE COMPANY | 294 | $67K |
| Short-term disability | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | 264 | $232K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 241 | $52K |
| Other(2 contracts, 2 carriers) | LIFEMAP ASSURANCE COMPANY | 294 | $49K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 294 | — |
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.