| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, INC | 15375 SE 30TH PL, #380 BELLEVUE, WA 98007 | REGENCE BLUESHIELD | $3.3M | $45K | $3.3M | 5.97% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, INC | 15375 SE 30TH PL, #380 BELLEVUE, WA 98007 | ASURIS NORTHWEST HEALTH | $841K | $11K | $852K | 6.52% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, INC | 15375 SE 30TH PL, #380 BELLEVUE, WA 98007 | DELTA DENTAL OF WASHINGTON | $351K | $0 | $351K | 7.00% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, INC | 15375 SE 30TH PL, #380 BELLEVUE, WA 98007 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC | $163K | $0 | $163K | 4.90% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, INC | 15375 SE 30TH PL, #380 BELLEVUE, WA 98007 | LIFEMAP ASSURANCE COMPANY | $73K | $0 | $73K | 12.88% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, INC | 15375 SE 30TH PL, #380 BELLEVUE, WA 98007 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON | $34K | $0 | $34K | 7.37% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES, INC | 15375 SE 30TH PL, #380 BELLEVUE, WA 98007 | LIFEMAP ASSURANCE COMPANY | $28K | $0 | $28K | 8.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EPK AND ASSOCIATES EIN 91-1947441 ADMINISTRATOR | Direct payment from the plan; Plan Administrator Service code 14 | — | $2.6M |
| JOHN S. CONNIFF, PLLC EIN 20-3527112 LAWYER | Legal; Direct payment from the plan Service code 29 | — | $36K |
| SWEENEY CONRAD, P.S. EIN 91-1301672 ACCOUNTANT | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $26K |
| CONOVER INSURANCE, INC. EIN 91-1123370 INSURER | Direct payment from the plan; Insurance agents and brokers Service code 22 | — | $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 | 11,144 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 94 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 11,238 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | REGENCE BLUESHIELD | 12,594 | $72.4M |
| Dental(2 contracts, 2 carriers) | REGENCE BLUESHIELD | 12,594 | $60.6M |
| Vision(3 contracts, 3 carriers) | REGENCE BLUESHIELD | 12,594 | $69.0M |
| Life insurance | LIFEMAP ASSURANCE COMPANY | 10,848 | $569K |
| Prescription drug(3 contracts, 3 carriers) | REGENCE BLUESHIELD | 12,594 | $59.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 12,594 | — |
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.