| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FCE BENEFIT ADMINISTRATORS, INC.3 Filed as: FCE BENEFIT ADMINISTRATORS INC | 1528 SOUTH EL CAMINO REAL, STE 307 SAN MATEO, CA 94402 | COMPANION LIFE INSURANCE COMPANY | $13K | — | $13K | 5.00% |
| FCE BENEFIT ADMINISTRATORS, INC.5 | 1528 SOUTH EL CAMINO REAL, STE 307 SAN MATEO, CA 94402 | COMPANION LIFE INSURANCE COMPANY | $3K | — | $3K | 2.00% |
| FCE BENEFIT ADMINISTRATORS, INC.3 Filed as: FCE BENEFIT ADMINISTRATORS INC | 1528 SOUTH EL CAMINO REAL, STE 307 SAN MATEO, CA 94402 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | $2K | $5K | 22.22% |
| FCE BENEFIT ADMINISTRATORS, INC.3 Filed as: FCE BENEFIT ADMINISTRATORS INC | 1528 SOUTH EL CAMINO REAL, STE 307 SAN MATEO, CA 94402 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $415 | $423 | $838 | 22.22% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| FCE BENEFIT ADMINISTRATORS, INC. EIN 33-0330036 PLAN SERVICE PROVIDER | Contract Administrator; Participant communication; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing Service code 12 | 1528 S EL CAMINO REAL, STE 307 SAN MATEO, CA 94402 | $157K |
| BROADREACH MEDICAL RESOURCES EIN 20-0640082 PLAN SERVICE PROVIDER | Claims processing Service code 12 | 1350 BROADWAY, SUITE 410 NEW YORK, NY 10018 | $18K |
| TRUST MANAGEMENT SERVICES EIN 46-3922133 PLAN SERVICE PROVIDER | Trustee (directed); Accounting (including auditing) Service code 10 | 1 ALMADEN BLVD, SUITE 950 SAN JOSE, CA 95113 | $8K |
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 | 205 | 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) | 205 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | COMPANION LIFE INSURANCE COMPANY | 52 | $145K |
| Dental | COMPANION LIFE INSURANCE COMPANY | 52 | $139K |
| Vision | COMPANION LIFE INSURANCE COMPANY | 52 | $139K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 219 | $22K |
| Short-term disability | COMPANION LIFE INSURANCE COMPANY | 52 | $139K |
| Stop-loss / reinsurancereinsurance | COMPANION LIFE INSURANCE COMPANY | 89 | $256K |
| Other(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 224 | $7K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 224 | — |
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.