| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JWCIB, INC.3 Filed as: JWCIB, INC DBA CAVIGNAC AND ASSOC | 451 A ST. , STE. 1800 SAN DIEGO, CA 921013630 | PRINCIPAL LIFE INSURANCE COMPANY | $820 | — | $820 | 1.33% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INSURANCE SERVICES | ATTN ACCOUNTING DEPT. 32110 AGOURA RD. WESTLAKE VLG, CA 913614026 | PRINCIPAL LIFE INSURANCE COMPANY | $0 | $410 | $410 | 0.67% |
| 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 | $3K | $3K | $5K | 22.04% |
| 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 | $465 | $466 | $931 | 22.04% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| FCE BENEFIT ADMINISTRATORS EIN 33-0330036 NONE | Plan Administrator Service code 14 | — | $132K |
| TRUST MANAGEMENT SERVICES EIN 46-3922133 NONE | Accounting (including auditing); Trustee (directed) Service code 10 | — | $24K |
| CIGNA HEALTH & LIFE INSURANCE CO EIN 59-1031071 NONE | Claims processing Service code 12 | — | $22K |
| GLOBAL CARE EIN 31-1407689 NONE | Other services Service code 49 | — | $10K |
| UNITED WORKERS WELLNESS EIN 87-2575833 NONE | Other services Service code 49 | — | $7K |
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 | 140 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 140 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | TELADOC HEALTH, INC. | 596 | $2K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 99 | $61K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 124 | $25K |
| Stop-loss / reinsurancereinsurance | FIDELITY SECURITY LIFE INSURANCE COMPANY | 110 | $553K |
| Other | RELIANCE STANDARD LIFE INSURANCE COMPANY | 124 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 596 | — |
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.