| 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 | $5.1M | $935K | $6.1M | 5.68% |
| 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. | $1.5M | — | $1.5M | 7.50% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL SUITE 380 BELLEVUE, WA 98007 | DELTA DENTAL OF WASHINGTON | $779K | — | $779K | 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 | $270K | — | $270K | 7.50% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL SUITE 380 BELLEVUE, WA 98007 | ASURIS NORTHWEST HEALTH | $106K | $44K | $150K | 6.60% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL SUITE 380 BELLEVUE, WA 98007 | LIFEMAP ASSURANCE COMPANY | $93K | — | $93K | 13.29% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL SUITE 380 BELLEVUE, WA 98007 | LIFEMAP ASSURANCE COMPANY | $40K | — | $40K | 8.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EPK & ASSOCIATES, INC. EIN 91-1947441 PLAN ADMINISTRATOR | Direct payment from the plan; Plan Administrator Service code 14 | — | $3.2M |
| FIRST CHOICE HEALTH EIN 91-1272766 EMPLOYEE ASSISTANCE | Direct payment from the plan; Other services Service code 49 | — | $214K |
| PERKINS COIE EIN 91-0591206 LAWYER | Legal; Direct payment from the plan Service code 29 | — | $112K |
| SWEENEY CONRAD, P.S. EIN 91-1301672 ACCOUNTANT | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $31K |
| CHUBB INSURANCE COMPANY EIN 13-2595722 INSURANCE AGENT | Direct payment from the plan; Insurance agents and brokers Service code 22 | — | $17K |
| CHARLES SCHWAB & CO., INC. EIN 94-1737782 TRUSTEE/CUSTODIAN | Direct payment from the plan; Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $16K |
| CAPITAL BENEFIT GROUP, LLC HR, COMPLIANCE ASSISTANCE | Other services; Direct payment from the plan Service code 49 | 15375 SE 30TH PL SUITE 380 BELLEVUE, WA 98007 | $7K |
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 | 16,812 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 104 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 16,916 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | REGENCE BLUESHIELD | 19,205 | $133.2M |
| Dental | DELTA DENTAL OF WASHINGTON | 22,544 | $11.1M |
| Vision(3 contracts, 3 carriers) | REGENCE BLUESHIELD | 19,205 | $109.8M |
| Life insurance | LIFEMAP ASSURANCE COMPANY | 17,223 | $701K |
| Prescription drug(4 contracts, 4 carriers) | REGENCE BLUESHIELD | 19,205 | $133.2M |
| Other(2 contracts, 2 carriers) | REGENCE BLUESHIELD | 19,205 | $107.7M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 22,544 | — |
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.