| 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 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | $29K | — | $29K | 0.17% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL STE 380 BELLEVUE, WA 98007 | DELTA DENTAL OF WASHINGTON | $711K | — | $711K | 7.00% |
| 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 | $986 | — | $986 | 0.03% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL STE 380 BELLEVUE, WA 98007 | DELTA DENTAL OF WASHINGTON | $84K | — | $84K | 8.00% |
| 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 | $90K | — | $90K | 10.00% |
| ASSUREDPARTNERS3 Filed as: EMERSON ROGERS LLC | 669 RIVER DR CENTER II STE 305 ELMWOOD PARK, NJ 07407 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $64K | $64K | 7.12% |
| 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 | $40K | — | $40K | 10.00% |
| ASSUREDPARTNERS3 Filed as: EMERSON ROGERS LLC | 669 RIVER DR CENTER II STE 305 ELMWOOD PARK, NJ 07407 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $29K | $29K | 7.17% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL STE 380 BELLEVUE, WA 98007 | REGENCE BLUESHIELD | $39K | — | $39K | 9.75% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL STE 380 BELLEVUE, WA 98007 | ASURIS NORTHWEST HEALTH | $2K | — | $2K | 6.52% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CAPITAL BENEFIT SERVICES, LLC EIN 91-1619527 INSURANCE AGENT/BROKER | Direct payment from the plan; Insurance agents and brokers Service code 22 | — | $7.0M |
| EPK & ASSOCIATES, INC. EIN 91-1947441 PLAN ADMINISTRATOR | Plan Administrator; Direct payment from the plan Service code 14 | — | $3.0M |
| FIRST CHOICE HEALTH EIN 91-1272766 EMPLOYEE ASSISTANCE | Direct payment from the plan; Other services Service code 49 | — | $192K |
| PERKINS COIE EIN 91-0591206 LAWYER | Legal; Direct payment from the plan Service code 29 | — | $76K |
| SWEENEY CONRAD, P.S. EIN 91-1301672 ACCOUNTANT | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $34K |
| L/P INSURANCE SERVICES LLC INSURANCE AGENT | Insurance agents and brokers; Direct payment from the plan Service code 22 | 300 EAST 2ND ST SUITE 1300 RENO, NV 89501 | $18K |
| CHARLES SCHWAB & CO, INC. EIN 94-1737782 TRUSTEE/CUSTODIAN | Trustee (bank, trust company, or similar financial institution); Direct payment from the plan Service code 21 | — | $14K |
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 | 14,979 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 106 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 15,085 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 5 carriers) | PREMERA BLUE CROSS | 19,651 | $112.1M |
| Dental | DELTA DENTAL OF WASHINGTON | 20,819 | $10.2M |
| Vision(3 contracts, 3 carriers) | DELTA DENTAL OF WASHINGTON | 15,140 | $1.5M |
| Life insurance(2 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 15,111 | $1.3M |
| Prescription drug(5 contracts, 5 carriers) | PREMERA BLUE CROSS | 19,651 | $112.1M |
| Other(2 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 15,111 | $1.3M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 20,819 | — |
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.