| 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 | $14K | — | $14K | 0.05% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL STE 380 BELLEVUE, WA 98007 | ASURIS NORTHWEST HEALTH | $3K | — | $3K | 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 | $180K | — | $180K | 6.97% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, LLC | 15375 SE 30TH PL STE 380 BELLEVUE, WA 98007 | DELTA DENTAL OF WASHINGTON | $27K | — | $27K | 8.00% |
| 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 | 26.17% |
| 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 | $17K | — | $17K | 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 | — | $11K | $11K | 25.17% |
| 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 | $6K | — | $6K | 15.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CAPITAL BENEFIT SERVICES, LLC EIN 91-1619527 INSURANCE AGENT / BROKER | Insurance agents and brokers; Direct payment from the plan Service code 22 | — | $2.4M |
| EPK & ASSOCIATES, INC. EIN 91-1947441 PLAN ADMINISTRATOR | Direct payment from the plan; Plan Administrator Service code 14 | — | $1.3M |
| FIRST CHOICE HEALTH EIN 91-1272766 EMPLOYEE ASSISTANCE | Direct payment from the plan; Other services Service code 49 | — | $64K |
| JOHN S. CONNIFF, PLLC EIN 20-3527112 LAWYER | Legal; Direct payment from the plan Service code 29 | — | $15K |
| SWEENEY CONRAD CPA, LLP EIN 41-2336714 ACCOUNTANT | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $10K |
| 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 | $8K |
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 | 12,407 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 70 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 12,477 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | REGENCE BLUESHIELD | 13,349 | $34.5M |
| Dental | DELTA DENTAL OF WASHINGTON | 12,773 | $2.6M |
| Vision | DELTA DENTAL OF WASHINGTON | 11,627 | $333K |
| Life insurance(2 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 12,858 | $154K |
| Prescription drug(4 contracts, 4 carriers) | REGENCE BLUESHIELD | 13,349 | $34.5M |
| Other | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 12,858 | $111K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 13,349 | — |
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.