# FORMFACTOR, INC. GROUP WELFARE BENEFIT PLAN

Health and welfare plan sponsored by **FORMFACTOR, INC.**. Form 5500 filing for plan year 2025.

| Field | Value |
|---|---|
| Sponsor | FORMFACTOR, INC. |
| EIN | 133711155 |
| Plan number | 502 |
| Plan year | 2025 |
| Location | LIVERMORE, CA |
| Industry | semiconductors |
| Funding | mixed |
| Total premiums | $26.1M |
| Participants | 1,579 |
| Persons covered | 1,579 |

## Insurance carriers (Schedule A)

| Carrier | Coverage |
|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY | Health, Rx, Dental, Indemnity |
| KAISER PERMANENTE | Health, Rx, HMO |
| RELIANCE STANDARD LIFE INSURANCE COMPANY | Life, STD, LTD, Indemnity, Other |
| FOUR EVER LIFE INSURANCE COMPANY | Health, Rx |
| METROPOLITAN GENERAL INSURANCE COMPANY | Other |
| TRUSTMARK INSURANCE COMPANY | Life, Other |
| FEDERAL INSURANCE COMPANY | Other |

## Brokers

| Broker | Placed with |
|---|---|
| MERCER HEALTH AND BENEFITS, LLC | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES |
| USI INSURANCE SERVICES LLC | RELIANCE STANDARD LIFE INSURANCE COMPANY |
| USI INSURANCE SERVICES LLC | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST |
| USI INSURANCE SERVICES LLC | FOUR EVER LIFE INSURANCE COMPANY |
| MERCER HEALTH AND BENEFITS, LLC | METROPOLITAN GENERAL INSURANCE COMPANY |
| USI INSURANCE SERVICES LLC | METROPOLITAN GENERAL INSURANCE COMPANY |
| BLTC FUNDING LLC | TRUSTMARK INSURANCE COMPANY |

## About this data

- Source: public Form 5500 filings from the U.S. Department of Labor (EBSA), rebuilt on each DOL release.
- Full page (charts, history, peer benchmarks, fees, contacts): https://planoptica.com/welfare/133711155-502
- Cite as: PlanOptica, https://planoptica.com/welfare/133711155-502
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