| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON PUERTO RICO | INSURANCE BROKERAGE INC 530 AVENUE DE LA CONSTITUCION SAN JUAN, PR 009012304 | TRIPLE S SALUD, INC. | $70K | — | $70K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC. EIN 39-1995276 CONTRACT ADMINISTRATOR | Contract Administrator; Direct payment from the plan Service code 13 | — | $46.1M |
| QUANTUM HEALTH, INC. EIN 20-8423895 CONTRACT ADMINISTRATOR | Contract Administrator; Direct payment from the plan Service code 13 | — | $21.9M |
| CVS PHARMACY, INC. EIN 05-0340626 OWNER OF THE PLAN'S PBM | Contract Administrator; Direct payment from the plan Service code 13 | — | $4.1M |
| DELTA DENTAL INSURANCE COMPANY EIN 94-2761537 CONTRACT ADMINISTRATOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $2.9M |
| SHARECARE, INC. EIN 27-0876664 CONTRACT ADMINISTRATOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $2.5M |
| NOX HEALTH GROUP FKA AS FUSION HEAL EIN 36-4797693 CONTRACT ADMINISTRATOR | Direct payment from the plan; Contract Administrator Service code 13 | — | $1.1M |
| HELLO HEART EIN 82-3489727 CONTRACT ADMINISTRATOR | Contract Administrator; Direct payment from the plan Service code 13 | — | $668K |
| BDO USA, P.C. EIN 13-5381590 AUDITOR | Direct payment from the plan; Accounting (including auditing) Service code 10 | — | $54K |
| UNITED HEALTHCARE SERVICES, INC. EIN 36-2735957 CONTRACT ADMINISTRATOR | Contract Administrator; Direct payment from the plan Service code 13 | — | $19K |
| JP MORGAN CHASE EIN 13-4994650 TRUSTEE | Direct payment from the plan; Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $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 | 82,846 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,143 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 83,989 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF HAWAII | 446 | $4.8M |
| Dental | TRIPLE S SALUD, INC. | 145 | $1.4M |
| Prescription drug(3 contracts, 2 carriers) | BLUE CROSS BLUE SHIELD OF HAWAII | 446 | $4.8M |
| Other | TRIPLE S SALUD, INC. | 145 | $1.4M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 446 | — |
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."
No prospect flags tripped on this filing.