| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AON CONSULTING INC3 Filed as: AON RISK SERVICES OF PR | 304 PONCE DE LEON AVE. SUITE 1000 SAN JUAN, PR 009191229 | TRIPLE S SALUD, INC. | $23K | — | $23K | 40.12% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE INSURANCE COMPANY EIN 36-2739571 NONE | Claims processing; Contract Administrator; Direct payment from the plan Service code 12 | — | $1.6M |
| HEWITT ASSOCIATES LLC EIN 36-2235791 NONE | Plan Administrator; Direct payment from the plan; Consulting (general) Service code 14 | — | $286K |
| LBI SOFTWARE ENGINEERING EIN 13-3118789 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $226K |
| CVS CAREMARK NONE | Direct payment from the plan; Other services Service code 49 | CVS HEALTH ONE CVS DRIVE WOONSOCKET, RI 02895 | $145K |
| DELTA DENTAL OF NY INC EIN 11-1980218 NONE | Claims processing; Contract Administrator; Direct payment from the plan Service code 12 | — | $124K |
| PRICEWATERHOUSECOOPERS LLP EIN 13-2781641 NONE | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $78K |
| DONNELLEY FINANCIAL SOLUTIONS NONE | Contract Administrator; Direct payment from the plan Service code 13 | 2001 KIRBY DRIVE, 4TH FLOOR HOUSTON, TX 77019 | $53K |
| EMPIRE BLUE CROSS BLUE SHIELD EIN 23-7391136 NONE | Direct payment from the plan; Contract Administrator; Claims processing Service code 12 | — | $28K |
| VISION SERVICE PLAN EIN 22-2586639 NONE | Direct payment from the plan; Contract Administrator; Claims processing Service code 12 | — | $27K |
| KILPATRICK STOCKTON LLP NONE | Direct payment from the plan; Investment management Service code 28 | 1001 WEST FOURTH STREET WINSTON-SALEM, NC 271012400 | $14K |
| MILLIMAN, USA NONE | Actuarial; Direct payment from the plan Service code 11 | 1301 FIFTH AVENUE, SUITE 3800 SEATTLE, WA 981012646 | $7K |
| KELLY SERVICES INC EIN 38-1510762 NONE | Consulting (general); Direct payment from the plan Service code 16 | — | $6K |
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 | 69 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4,337 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 2,584 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 6,990 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | UNITED BEHAVIORAL HEALTH DBA OPTUM | 7,704 | $179K |
| Dental | TRIPLE S SALUD, INC. | 31 | $57K |
| Prescription drug | TRIPLE S SALUD, INC. | 31 | $57K |
| Other | TRIPLE S SALUD, INC. | 31 | $57K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 7,704 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.