| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSONSOUTHEAST INC. | P.O. BOX 13784 NEWARK, NJ 071880784 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $5K | $12K | $16K | 1.28% |
| FCE BENEFIT ADMINISTRATORS, INC.3 | 1528 S EL CAMINO REAL STE 407 SAN MATEO, CA 94402 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $15K | — | $15K | 4.92% |
| FCE BENEFIT ADMINISTRATORS, INC.3 | — | KAISER FOUNDATION HEALTH PLAN INC | $9K | $2K | $11K | 6.07% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC | 12505 PARK POTOMAC AVENUE SUITE 300 POTOMAC, MD 20854 | HARTFORD LIFE AND ACCIDENT | $3K | — | $3K | 3.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON INSURANCE | 801 S FIGUEROA STREET SUITE 800 LOS ANGELES, CA 90017 | HARTFORD LIFE AND ACCIDENT | — | $2K | $2K | 2.20% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC | PO BOX 13784 NEWARK, NJ 071880001 | VISION SERVICE PLAN | $646 | — | $646 | 5.01% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC. | — | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 13.84% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC. | — | LIFE INSURANCE COMPANY NORTH AMERICA | $950 | — | $950 | 13.67% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | — | LIFE INSURANCE COMPANY OF NORTH AMERICA | $897 | — | $897 | 13.82% |
| FCE BENEFIT ADMINISTRATORS, INC.3 Filed as: FCE BENEFIT ADMINISTRATORS INC | 1528 S EL CAMINO REAL SUITE 407 SAN MATEO, CA 94402 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $901 | — | $901 | 14.99% |
| FCE BENEFIT ADMINISTRATORS, INC.3 Filed as: FCE BENEFIT ADMINISTRATORS INC | 1528 S EL CAMINIO REAL SUITE 407 SAN MATEO, CA 94402 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $414 | — | $414 | 8.34% |
| FCE BENEFIT ADMINISTRATORS, INC.3 Filed as: FCE BENEFIT ADMINISTRATORS INC | 1528 S EL CAMINO REAL SUITE 407 SAN MATEO, CA 94402 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $585 | — | $585 | 14.99% |
| FCE BENEFIT ADMINISTRATORS, INC.3 Filed as: FCE BENEFIT ADMINISTRATORS INC | 1528 S EL CAMINO REAL SUITE 407 SAN MATEO, CA 94402 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $275 | $283 | $558 | 22.30% |
| FCE BENEFIT ADMINISTRATORS, INC.3 Filed as: FCE BENEFIT ADMINISTRATORS INC | 1528 S EL CAMINO REAL SUITE 407 SAN MATEO, CA 94402 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $80 | — | $80 | 6.53% |
| FCE BENEFIT ADMINISTRATORS, INC.3 Filed as: FCE BENEFIT ADMINISTRATORS INC | 1528 S EL CAMINO REAL SUITE 407 SAN MATEO, CA 94402 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $47 | $48 | $95 | 22.25% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| FCE BENEFIT ADMINISTRATORS, INC. EIN 33-0330036 NONE | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Other insurance fees and expenses; Claims processing Service code 12 | 1528 SOUTH EL CAMINO REAL SUITE 407 SAN MATEO, CA 94402 | $119K |
| FIDUCIARY PLAN MANAGEMENT SERVICES EIN 46-3922133 NONE | Trustee (directed); Accounting (including auditing) Service code 10 | A ALMADEN BLVD, STE 620 SAN JOSE, CA 95113 | $37K |
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 NONE | Other services Service code 49 | PO BOX 645014 CINCINNATI, OH 452645014 | $17K |
| BUSINESS BENEFITS GROUP EIN 54-1769053 NONE | Participant communication; Contract Administrator Service code 13 | 4069 CHAIN BRIDGE RD FAIRFAX, VA 22030 | $10K |
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 | 198 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 198 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 5 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 102 | $1.5M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 102 | $1.3M |
| Vision(2 contracts, 2 carriers) | VISION SERVICE PLAN | 103 | $18K |
| Life insurance(3 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 128 | $98K |
| Stop-loss / reinsurancereinsurance | FIDELITY SECURITY LIFE INSURANCE COMPANY | 83 | $305K |
| Other(5 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 102 | $29K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 128 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.