| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FCE BENEFIT ADMINISTRATORS, INC.3 | 1528 S EL CAMINO REAL STE 407 SAN MATEO, CA 944023071 | KAISER FOUNDATION HEALTH PLAN, INC. | $7K | — | $7K | 5.37% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC. | PO BOX 13784 NEWARK, NJ 07188 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $487 | — | $487 | 3.00% |
| WILLIS TOWERS WATSON US LLC5 Filed as: WILLIS TOWERS WATSON INSURANCE SRVC | PO BOX 101162 PASADENA, CA 91189 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $207 | $207 | 1.28% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC. | PO BOX 13784 NEWARK, NJ 07188 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $473 | — | $473 | 3.00% |
| WILLIS TOWERS WATSON US LLC5 Filed as: WILLIS TOWERS WATSON INSURANCE SRVC | PO BOX 101162 PASADENA, CA 91189 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $251 | $251 | 1.59% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC. | PO BOX 13784 NEWARK, NJ 07188 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $367 | — | $367 | 3.00% |
| WILLIS TOWERS WATSON US LLC5 Filed as: WILLIS TOWERS WATSON INSURANCE SRVC | PO BOX 101162 PASADENA, CA 91189 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $122 | $122 | 1.00% |
| 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 | $607 | — | $607 | 5.40% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC. | PO BOX 13784 NEWARK, NJ 07188 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $1K | — | $1K | 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 | $809 | — | $809 | 9.53% |
| WILLIS TOWERS WATSON US LLC5 Filed as: WILLIS TOWERS WATSON INSURANCE SRVC | PO BOX 101162 PASADENA, CA 91189 | NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | — | $93 | $93 | 1.10% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC. | PO BOX 13784 NEWARK, NJ 07188 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $768 | — | $768 | 15.01% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC. | PO BOX 13784 NEWARK, NJ 07188 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $553 | — | $553 | 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 | $89 | — | $89 | 3.00% |
| WILLIS TOWERS WATSON US LLC5 Filed as: WILLIS TOWERS WATSON INSURANCE SRVC | PO BOX 101162 PASADENA, CA 91189 | LIFE INSURANCE COMPANY OF NORTH AMERICA | — | $17 | $17 | 0.57% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| INEICH & COMPANY, LLP EIN 56-2552172 NONE | Accounting (including auditing) Service code 10 | — | $25K |
| FCE BENEFIT ADMINISTRATORS, INC. EIN 33-0330036 NONE | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 13 | — | $18K |
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 | 110 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 110 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | CIGNA HEALTH & LIFE INSURANCE COMPANY | 91 | $1.1M |
| Dental | CIGNA HEALTH & LIFE INSURANCE COMPANY | 91 | $1.0M |
| Vision | VISION SERVICE PLAN | 84 | $11K |
| Life insurance(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 116 | $19K |
| Short-term disability(3 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 110 | $28K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 32 | $12K |
| Other(2 contracts) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 22 | $15K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 116 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.