| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FCE BENEFIT ADMINISTRATORS, INC.3 Filed as: FCE BENEFIT ADMINISTRATORS INC | 887 MITTEN ROAD, SUITE 200 BURLINGAME, CA 94010 | UNITEDHEALTHCARE INSURANCE COMPANY | $233K | — | $233K | 2.97% |
| 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 | $2K | 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 | $180 | $198 | $378 | 20.97% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| FCE BENEFIT ADMINISTRATORS, INC. EIN 33-0330036 NONE | Contract Administrator; Insurance brokerage commissions and fees; Other insurance fees and expenses; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 13 | 887 MITTEN ROAD BURLINGAME, CA 94010 | $224K |
| WILLIS OF MARYLAND, INC. EIN 52-0559369 NONE | Contract Administrator; Participant communication Service code 13 | 225 SCHILLING CIRCLE, SUITE 150 HUNT VALLEY, MD 21031 | $69K |
| TRUST MANAGEMENT SERVICES EIN 46-3922133 | Accounting (including auditing); Trustee (directed) Service code 10 | 831 MITTEN ROAD, SUITE 215 BURLINGAME, CA 94010 | $23K |
| 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 | 357 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 357 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 2,112 | $8.3M |
| Dental | MADISON NATIONAL LIFE INSURANCE COMPANY, INC. | 267 | $117K |
| Vision | MADISON NATIONAL LIFE INSURANCE COMPANY, INC. | 267 | $117K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 285 | $11K |
| Short-term disability | MADISON NATIONAL LIFE INSURANCE COMPANY, INC. | 267 | $117K |
| Prescription drug | FIDELITY SECURITY LIFE INSURANCE COMPANY | 0 | $6K |
| Other(2 contracts, 2 carriers) | MAGELLAN BEHAVIORAL HEALTH | 322 | $8K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,112 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.