| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FCE BENEFIT ADMINISTRATORS, INC.3 | 1528 SOUTH EL CAMINO REAL, STE 407 SAN MATEO, CA 94402 | COMPANION LIFE INSURANCE COMPANY | $21K | — | $21K | 5.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MARYLAND INC | 225 SCHILLING CIR, STE 150 HUNT VALLEY, MD 210311126 | HUMANA INSURANCE COMPANY | $4K | — | $4K | 9.92% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MARYLAND INC | PO BOX 13784 NEWARK, NJ 07188 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $6K | — | $6K | 15.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MARYLAND INC | PO BOX 13784 NEWARK, NJ 07188 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 15.00% |
| FCE BENEFIT ADMINISTRATORS, INC.3 | 1528 SOUTH EL CAMINO REAL, STE 407 SAN MATEO, CA 94402 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | — | $2K | 11.00% |
| FCE BENEFIT ADMINISTRATORS, INC.5 | 1528 SOUTH EL CAMINO REAL, STE 407 SAN MATEO, CA 94402 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $2K | $2K | 10.30% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MARYLAND INC | PO BOX 13784 NEWARK, NJ 07188 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 15.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS HRH | 225 SHILLING CIRCLE STE 150 HUNT VALLEY, MD 21031 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $1K | — | $1K | 10.13% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $68 | — | $68 | 0.51% |
| FCE BENEFIT ADMINISTRATORS, INC.3 | 1528 SOUTH EL CAMINO REAL, STE 407 SAN MATEO, CA 94402 | EYEMED | $223 | — | $223 | 2.50% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MARYLAND INC | PO BOX 13784 NEWARK, NJ 07188 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $462 | — | $462 | 12.00% |
| FCE BENEFIT ADMINISTRATORS, INC.5 Filed as: FCE BENEFIT ADMINISTRATORS, INC | 1528 SOUTH EL CAMINO REAL, STE 407 SAN MATEO, CA 94402 | FIDELITY SECURITY LIFE INSURANCE COMPANY | — | $1K | $1K | 32.39% |
| FCE BENEFIT ADMINISTRATORS, INC.3 Filed as: FCE BENEFIT ADMINISTRATORS, INC | 1528 SOUTH EL CAMINO REAL, STE 407 SAN MATEO, CA 94402 | FIDELITY SECURITY LIFE INSURANCE COMPANY | $157 | — | $157 | 4.98% |
| FCE BENEFIT ADMINISTRATORS, INC.3 Filed as: FCE BENEFIT ADMINISTRATORS INC | 1528 SOUTH EL CAMINO REAL, STE 407 SAN MATEO, CA 94402 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $322 | — | $322 | 10.99% |
| FCE BENEFIT ADMINISTRATORS, INC.5 Filed as: FCE BENEFIT ADMINISTRATORS INC | 1528 SOUTH EL CAMINO REAL, STE 407 SAN MATEO, CA 94402 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $302 | $302 | 10.31% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MARYLAND INC | 225 SCHILLING CIRCLE, SUITE 150 HUNT VALLEY, MD 21031 | METROPOLITAN PROPERTY AND CASUALTY INSURANCE CO. | $318 | — | $318 | 11.56% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF MARYLAND INC | PO BOX 13784 NEWARK, NJ 07188 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $44 | — | $44 | 12.12% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| FCE BENEFIT ADMINISTRATORS, INC. EIN 33-0330036 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | 1528 S. EL CAMINO REAL, SUITE 407 SAN MATEO, CA 94402 | $146K |
| WILLIS OF MARYLAND, INC. EIN 52-0559369 NONE | Contract Administrator; Participant communication Service code 13 | 225 SCHILLING CIRCLE, SUITE 150 HUNT VALLEY, MD 21031 | $34K |
| FIDUCIARY PLAN MANAGEMENT SERVICES EIN 46-3922133 NONE | Trustee (directed); Accounting (including auditing) Service code 10 | 1 ALMADEN BOULEVARD, SUITE 620 SAN JOSE, CA 95113 | $30K |
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 NONE | Other services Service code 49 | — | $21K |
| FCE FINANCIAL SERVICES, INC. EIN 80-0636312 NONE | Contract Administrator; Participant communication Service code 13 | 1528 S. EL CAMINO REAL, SUITE 407 SAN MATEO, CA 94402 | $11K |
| FCE BENEFIT ADMINISTRTORS, INC. | Other insurance fees and expenses Service code 73 | — | $11K |
| SOUTHERN SCRIPTS NONE | Claims processing Service code 12 | PO BOX 896599 CHARLOTTE, NC 28289 | $9K |
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 | 287 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 287 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 133 | $1.0M |
| Dental(2 contracts, 2 carriers) | COMPANION LIFE INSURANCE COMPANY | 151 | $104K |
| Vision(2 contracts, 2 carriers) | FIDELITY SECURITY LIFE INSURANCE COMPANY | 139 | $22K |
| Life insurance(3 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 212 | $38K |
| Short-term disability(2 contracts, 2 carriers) | COMPANION LIFE INSURANCE COMPANY | 209 | $98K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 209 | $18K |
| Prescription drug | FIDELITY SECURITY LIFE INSURANCE COMPANY | 2 | $3K |
| Stop-loss / reinsurancereinsurance | COMPANION LIFE INSURANCE COMPANY | 139 | $415K |
| Other(4 contracts, 3 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 212 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 212 | — |
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.