| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| OLYMPIC AGENCY INC3 Filed as: OLYMPIC AGENCY, INC. | PMB 273 1353 CARR 19 GUAYNABO, PR 009662700 | DELTA DENTAL OF PUERTO RICO, INC. | $129 | — | $129 | 0.12% |
| CGF INSURANCE LLC3 Filed as: CGF INSURANCE, LLC | 22 AVENIDA GONZALEZ GIUSTI CAPARRA OFFICE CENTER STE 200 GUAYNABO, PR 009683011 | DELTA DENTAL OF PUERTO RICO, INC. | $128 | — | $128 | 0.12% |
| SAUL R LOCKER3 Filed as: SAUL R. LOCKER | 1099 EIGHTEENTH ST. SUITE 2870 DENVER, CO 80202 | HARTFORD LIFE AND ACCIDENT | $4K | $3K | $7K | 16.01% |
No Schedule C service providers reported on this filing.
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 | 1,028 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,028 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PAN AMERICAN LIFE INSURANCE GROUP | 1,028 | $157K |
| Dental | DELTA DENTAL OF PUERTO RICO, INC. | 543 | $106K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 587 | $42K |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 587 | $53K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,028 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.