| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FCE BENEFIT ADMINISTRATORS, INC.5 Filed as: FCE BENEFIT ADMINISTRATORS INC | 887 MITTEN ROAD, SUITE 200 BURLINGAME, CA 94010 | MADISON NATIONAL LIFE INSURANCE COMPANY, INC. | $14K | $0 | $14K | 2.00% |
| FCE BENEFIT ADMINISTRATORS, INC.3 Filed as: FCE BENEFIT ADMINISTRATORS INC | 887 MITTEN ROAD, SUITE 200 BURLINGAME, CA 94010 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $6K | $7K | $13K | 21.00% |
| FCE BENEFIT ADMINISTRATORS, INC.3 Filed as: FCE BENEFIT ADMINISTRATORS INC | 887 MITTEN ROAD, SUITE 200 BURLINGAME, CA 94010 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $1K | $1K | $3K | 21.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| FCE BENEFIT ADMINISTRATORS, INC. EIN 33-0330036 NONE | Other services; Other insurance fees and expenses; Contract Administrator; Claims processing; Insurance brokerage commissions and fees; Participant communication; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | 887 MITTEN ROAD BURLINGAME, CA 94010 | $1.1M |
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 NONE | Contract Administrator; Other services; Float revenue; Claims processing; Non-monetary compensation; Named fiduciary; Participant communication; Direct payment from the plan Service code 12 | — | $53K |
| TRUST MANAGEMENT SERVICES EIN 46-3922133 NONE | Trustee (directed); Accounting (including auditing) Service code 10 | 831 MITTEN ROAD, SUITE 215 BURLINGAME, CA 94010 | $46K |
| GALLINA LLP EIN 94-2147510 NONE | Accounting (including auditing) Service code 10 | 2870 GOLD TAILINGS COURT RANCHO CORDOVA, CA 95670 | $11K |
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 | 863 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 863 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | MADISON NATIONAL LIFE INSURANCE COMPANY, INC. | 491 | $711K |
| Dental | MADISON NATIONAL LIFE INSURANCE COMPANY, INC. | 491 | $711K |
| Vision | MADISON NATIONAL LIFE INSURANCE COMPANY, INC. | 491 | $711K |
| Life insurance(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 607 | $63K |
| Prescription drug | FIDELITY SECURITY LIFE INSURANCE COMPANY | 0 | $153K |
| Other(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 876 | $26K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 876 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.