| 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 | $3.4M | $40K | $3.4M | 5.90% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES INC | 15375 SE 30TH PL, #380 BELLEVUE, WA 98007 | ASURIS NORTHWEST HEALTH | $585K | $6K | $591K | 6.34% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES INC | 15375 SE 30TH PL, #380 BELLEVUE, WA 98007 | DELTA DENTAL OF WASHINGTON | $375K | $0 | $375K | 8.14% |
| 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. | $89K | $0 | $89K | 7.48% |
| 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 | $57K | $0 | $57K | 7.36% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES INC | 15375 SE 30TH PL, #380 BELLEVUE, WA 98007 | LIFEMAP ASSURANCE COMPANY | $67K | $0 | $67K | 12.94% |
| CAPITAL BENEFIT SERVICES, INC.3 Filed as: CAPITAL BENEFIT SERVICES INC | 15375 SE 30TH PL, #380 BELLEVUE, WA 98007 | LIFEMAP ASSURANCE COMPANY | $26K | $0 | $26K | 8.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EPK AND ASSOCIATES EIN 91-1947441 ADMINISTRATOR | Plan Administrator; Direct payment from the plan Service code 14 | — | $2.5M |
| FIRST CHOICE HEALTH EIN 91-1272766 EMPLOYEE ASSISTANCE | Direct payment from the plan; Other services Service code 49 | — | $41K |
| JOHN S. CONNIFF, PLLC EIN 20-3527112 LAWYER | Legal; Direct payment from the plan Service code 29 | — | $30K |
| SWEENEY CONRAD, P.S EIN 91-1301672 ACCOUNTANT | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $27K |
| KEY TRUST COMPANY EIN 34-0797057 TRUSTEE CUSTODIAN | Trustee (bank, trust company, or similar financial institution); Direct payment from the plan Service code 21 | — | $9K |
| CONOVER INSURANCE, INC. EIN 91-1123370 INSURER | Insurance agents and brokers; Direct payment from the plan 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 | 10,312 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 80 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 10,392 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | REGENCE BLUESHIELD | 13,108 | $69.4M |
| Dental(2 contracts, 2 carriers) | REGENCE BLUESHIELD | 13,108 | $62.8M |
| Vision(3 contracts, 3 carriers) | REGENCE BLUESHIELD | 13,108 | $67.8M |
| Life insurance | LIFEMAP ASSURANCE COMPANY | 10,803 | $519K |
| Prescription drug(3 contracts, 3 carriers) | REGENCE BLUESHIELD | 13,108 | $60.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 13,108 | — |
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.