| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| OLYMPIC AGENCY INC3 | PMB 370,1353 CARR.19 GUAYNABO, PR 00966 | TRIPLE S SALUD INC | $375K | $0 | $375K | 3.75% |
| CGF INSURANCE LLC3 | CAPARRA OFFICE CENTER AVE. GONZALEZ GUISTI SUITE 202 GUAYNABO, PR 009083011 | TRIPLE S SALUD INC | $0 | $0 | $0 | 0.00% |
| OLYMPIC AGENCY INC3 | PMB 370,1353 CARR.19 GUAYNABO, PR 00966 | UNITED HEALTHCARE INSURANCE COMPANY | $75K | $5K | $80K | 4.29% |
| INNOVA INSURANCE3 | PO BOX 299 MERCEDITA, PR 00715 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $60K | $0 | $60K | 20.00% |
| INNOVA INSURANCE3 | PO BOX 299 MERCEDITA, PR 00715 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $51K | $0 | $51K | 20.00% |
| CGF INSURANCE LLC3 | CAPARRA OFFICE CENTER AVE. GONZALEZ GUISTI SUITE 202 GUAYNABO, PR 009683011 | FIRST MEDICAL HEALTH PLAN INC | $7K | $0 | $7K | 4.00% |
| OLYMPIC AGENCY INC3 | PMB 370,1353 CARR.19 GUAYNABO, PR 00966 | MCS LIFE INSURANCE COMPANY | $2K | $0 | $2K | 2.66% |
| CGF INSURANCE LLC3 | CAPARRA OFFICE CENTER AVE. GONZALEZ GUISTI SUITE 202 GUAYNABO, PR 009683011 | MCS LIFE INSURANCE COMPANY | $0 | $790 | $790 | 0.97% |
| INNOVA INSURANCE3 | PO BOX 299 MERCEDITA, PR 00715 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $10K | $0 | $10K | 20.00% |
| INNOVA INSURANCE3 | PO BOX 299 MERCEDITA, PR 00715 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $0 | $3K | 20.00% |
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 | 2,324 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 456 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,780 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 4 carriers) | TRIPLE S SALUD INC | 1,818 | $12.1M |
| Dental(3 contracts, 3 carriers) | TRIPLE S SALUD INC | 1,818 | $10.3M |
| Life insurance(2 contracts, 2 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,324 | $380K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 2,324 | $255K |
| Prescription drug(3 contracts, 3 carriers) | TRIPLE S SALUD INC | 1,818 | $10.3M |
| Other(3 contracts, 2 carriers) | TRIPLE S SALUD INC | 2,324 | $10.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,324 | — |
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.