| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSONSOUTHEAST INC. | PO BOX 13784 NEWARK, NJ 071880784 | CIGNA HEALTH & LIFE INSURANCE COMPANY | — | $9K | $9K | 0.94% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSONSOUTHEAST INC. | PO BOX 13784 NEWARK, NJ 071880784 | CIGNA HEALTH & LIFE INSURANCE COMPANY | $3K | — | $3K | 0.32% |
| FCE BENEFIT ADMINISTRATORS, INC.3 | 1528 S EL CAMINO REAL STE 407 SAN MATEO, CA 944023071 | KAISER FOUNDATION HEALTH PLAN, INC. | $8K | — | $8K | 4.89% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC. | PO BOX 13784 NEWARK, NJ 07188 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $386 | — | $386 | 3.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC. | PO BOX 13784 NEWARK, NJ 07188 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $420 | — | $420 | 3.34% |
| WILLIS TOWERS WATSON US LLC5 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC | PO BOX 13784 NEWARK, NJ 071880001 | VISION SERVICE PLAN | — | $2K | $2K | 21.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC | PO BOX 13784 NEWARK, NJ 071880001 | VISION SERVICE PLAN | $505 | — | $505 | 4.60% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC. | PO BOX 13784 NEWARK, NJ 07188 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $1K | — | $1K | 15.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC. | PO BOX 13784 NEWARK, NJ 07188 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $262 | — | $262 | 3.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC. | PO BOX 13784 NEWARK, NJ 07188 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $803 | — | $803 | 15.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC. | PO BOX 13784 NEWARK, NJ 07188 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $627 | — | $627 | 15.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC. | PO BOX 13784 NEWARK, NJ 07188 | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | $332 | — | $332 | 10.01% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC. | PO BOX 13784 NEWARK, NJ 07188 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $44 | — | $44 | 3.30% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| FCE BENEFIT ADMINISTRATORS, INC. EIN 33-0330036 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator Service code 13 | 1528 S EL CAMINO REAL, STE. 407 SAN MATEO, CA 94402 | $25K |
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 | 111 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 111 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | CIGNA HEALTH & LIFE INSURANCE COMPANY | 86 | $1.1M |
| Dental | CIGNA HEALTH & LIFE INSURANCE COMPANY | 86 | $911K |
| Vision | VISION SERVICE PLAN | 86 | $11K |
| Life insurance(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 114 | $14K |
| Short-term disability(3 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 114 | $20K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 33 | $9K |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 20 | $14K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 114 | — |
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.