| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FCE BENEFIT ADMINISTRATORS, INC.3 | 887 MITTEN ROAD BURLINGAME, CA 94010 | MADISON NATIONAL LIFE INSURANCE COMPANY, INC. | $19K | — | $19K | 3.76% |
| FCE BENEFIT ADMINISTRATORS, INC.5 | 887 MITTEN ROAD BURLINGAME, CA 94010 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $5K | $5K | 11.00% |
| FCE BENEFIT ADMINISTRATORS, INC.3 | 887 MITTEN ROAD BURLINGAME, CA 94010 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $5K | — | $5K | 10.00% |
| FCE BENEFIT ADMINISTRATORS, INC.5 | 887 MITTEN ROAD BURLINGAME, CA 94010 | RELIANCE STANDARD LIFE INSURANCE COMPANY | — | $932 | $932 | 11.00% |
| FCE BENEFIT ADMINISTRATORS, INC.3 | 887 MITTEN ROAD BURLINGAME, CA 94010 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $847 | — | $847 | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| FCE BENEFIT ADMINISTRATORS EIN 33-0330036 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Participant communication; Claims processing Service code 12 | 887 MITTEN ROAD BURLINGAME, CA 94010 | $998K |
| TRUST MANAGEMENT SERVICES EIN 46-3922133 NONE | Trustee (directed); Accounting (including auditing) Service code 10 | 831 MITTEN ROAD, SUITE 215 BURLINGAME, CA 94010 | $106K |
| INEICH & COMPANY, LLP EIN 56-2552172 NONE | Accounting (including auditing) Service code 10 | 950 TOWER LANE, SUITE 780 FOSTER CITY, CA 94404 | $10K |
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 | 790 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 790 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | MADISON NATIONAL LIFE INSURANCE COMPANY, INC. | 191 | $504K |
| Dental | MADISON NATIONAL LIFE INSURANCE COMPANY, INC. | 191 | $496K |
| Vision | MADISON NATIONAL LIFE INSURANCE COMPANY, INC. | 191 | $496K |
| Life insurance | RELIANCE STANDARD LIFE INSURANCE COMPANY | 212 | $50K |
| Short-term disability | MADISON NATIONAL LIFE INSURANCE COMPANY, INC. | 191 | $496K |
| Prescription drug | FIDELITY SECURITY LIFE INSURANCE COMPANY | 790 | $50K |
| Other(2 contracts, 2 carriers) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 631 | $16K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 790 | — |
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.