| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FCE BENEFIT ADMINISTRATORS, INC.3 Filed as: FCE BENEFIT ADMINISTRATORS | 887 MITTEN ROAD BURLINGAME, CA 94010 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $11K | — | $11K | 4.60% |
| FCE BENEFIT ADMINISTRATORS, INC.3 Filed as: FCE BENEFIT ADMINISTRATORS | 887 MITTEN ROAD BURLINGAME, CA 94010 | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | $8K | — | $8K | 4.60% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 NONE | Contract Administrator Service code 13 | 151 FARMINGTON AVENUE HARTFORD, CT 06156 | $249K |
| FCE BENEFIT ADMINISTRATORS INC EIN 33-0330036 NONE | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 13 | 887 MITTEN ROAD BURLINGAME, CA 940101303 | $67K |
| PAYFLEX SYSTEMS USA, INC. NONE | Claims processing Service code 12 | 10802 FARNAM DRIVE OMAHA, NE 68154 | $16K |
| UNITED CONCORDIA COMPANIES, INC. EIN 25-1687586 NONE | Claims processing Service code 12 | 4401 DEER PATH ROAD HARRISBURG, PA 17106 | $15K |
| TRUST MANAGEMENT SERVICES EIN 46-3922133 NONE | Accounting (including auditing); Trustee (directed) Service code 10 | 831 MITTEN ROAD, SUITE 215 BURLINGAME, CA 94010 | $15K |
| INEICH & COMPANY, LLP EIN 56-2552172 NONE | Accounting (including auditing) Service code 10 | 950 TOWER LANE, SUITE 780 FOSTER CITY, CA 94404 | $14K |
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 | 738 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 738 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 17 | $42K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 17 | $42K |
| Life insurance(4 contracts, 3 carriers) | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 691 | $260K |
| Short-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 421 | $14K |
| Long-term disability | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 620 | $172K |
| Other(3 contracts, 3 carriers) | LIBERTY LIFE ASSURANCE COMPANY OF BOSTON | 691 | $291K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 691 | — |
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.