| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AON CONSULTING INC3 Filed as: HEWITT INSURANCE, INC | 304 PONCE DE LEON AVE. SUITE 1000 SAN JUAN, PR 009191229 | TRIPLE S SALUD, INC. | $3K | — | $3K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE EIN 36-2739571 NONE | Claims processing; Direct payment from the plan; Contract Administrator Service code 12 | — | $1.7M |
| HEWITT ASSOCIATES LLC EIN 36-2235791 NONE | Direct payment from the plan; Consulting (general); Plan Administrator Service code 14 | — | $895K |
| DELTA DENTAL OF NY INC EIN 11-1980218 NONE | Contract Administrator; Direct payment from the plan; Claims processing Service code 12 | — | $134K |
| LBI SOFTWARE ENGINEERING EIN 13-3118789 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $113K |
| EMPIRE BLUE CROSS BLUE SHIELD EIN 23-7391136 NONE | Direct payment from the plan; Claims processing; Contract Administrator Service code 12 | — | $54K |
| AXA EQUITABLE EIN 13-5570651 NONE | Other services; Direct payment from the plan; Copying and duplicating Service code 36 | — | $40K |
| KELLY SERVICES INC EIN 38-1510762 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $39K |
| RR DONNELLEY NONE | Direct payment from the plan; Contract Administrator Service code 13 | 2075 BUSSE ROAD ELK GROVE VILLAGE, IL 60007 | $37K |
| VISION SERVICE PLAN EIN 22-2586639 NONE | Direct payment from the plan; Contract Administrator; Claims processing Service code 12 | — | $23K |
| JP MORGAN CHASE BANK, NA EIN 13-4994650 TRUSTEE | Trustee (bank, trust company, or similar financial institution); Custodial (securities); Direct payment from the plan Service code 19 | — | $7K |
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 | 101 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5,056 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2,331 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 7,488 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITED BEHAVIORAL HEALTH DBA OPTUM | 7,799 | $134K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 7,799 | — |
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.