No insurance carriers on this filing. Self-funded welfare plans typically pay TPAs and PBMs through Schedule C, not Schedule A.
No brokers reported on this filing.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| TRIPLE S SALUD EIN 66-0555677 NONE | Other services Service code 49 | PO BOX 71548 SAN JUAN, PR 00936 | $474K |
| MCS LIFE INSURANCE COMPANY EIN 66-0520918 NONE | Other services Service code 49 | PO BOX 193310 SAN JUAN, PR 00919 | $309K |
| FIRST MEDICAL HEALTH PLAN INC EIN 66-0537624 NONE | Other services Service code 49 | PO BOX 70264 SAN JUAN, PR 00936 | $247K |
| MAPFRE LIFE INSURANCE COMPANY EIN 66-0402309 NONE | Other services Service code 49 | PO BOX 70297 SAN JUAN, PR 00936 | $187K |
| DELTA DENTAL OF PR INC EIN 66-0436769 NONE | Other services Service code 49 | METRO OFFICE PARK 14 CALLE 2 SUITE 200 GUAYNABO, PR 00968 | $90K |
| EFRAIN SOTO DE JESUS EIN 58-3548158 EMPLOYEE | Employee (plan) Service code 30 | URB CAMPO ALEGRE C-34 CALLE ROBLES BAYAMON, PR 00956 | $56K |
| VICTOR M ORTEGA RAMON EIN 58-4205792 EMPLOYEE | Employee (plan) Service code 30 | URB VILLA BORINQUEN 405 CALLE DUERO SAN JUAN, PR 00920 | $37K |
| AIDA L ORTIZ RODRIGUEZ EIN 58-1415086 EMPLOYEE | Employee (plan) Service code 30 | URB SUMMIT HILLS 554 CALLE YUNQUE SAN JUAN, PR 00920 | $32K |
| YOLANDA LANDRAU RAMOS EIN 58-1650227 EMPLOYEE | Employee (plan) Service code 30 | URB SANTA ROSA 31-5 CALLE 28 BAYAMON, PR 00959 | $31K |
| LCDO JOSE E CARRERAS ROVIRA EIN 58-4109164 NONE | Legal Service code 29 | 352 CALLE DEL PARQUE C-5 SAN JUAN, PR 00912 | $26K |
| MARYCELIS TORRENS CORTIJO EIN 59-7187634 EMPLOYEE | Employee (plan) Service code 30 | URB JARDINES DE RIO GRANDE BY-439 CALLE 74 RIO GRANDE, PR 00745 | $25K |
| ROSA M VELEZ AVILES EIN 58-3208260 EMPLOYEE | Employee (plan) Service code 30 | URB LA INMACULADA G-3 CALLE CRUZ TOA BAJA, PR 00949 | $22K |
| HOSPITAL WILMA N VAZQUEZ EIN 66-0403210 NONE | Other services Service code 49 | PO BOX 7001 VEGA BAJA, PR 00694 | $19K |
| DOCTORS CENTER HOSPITAL BAYAMON EIN 66-0265947 NONE | Other services Service code 49 | PO BOX 30532 MANATI, PR 00674 | $19K |
| DOCTORS CENTER HOSPITAL SJ EIN 66-0199045 NONE | Other services Service code 49 | PO BOX 30532 MANATI, PR 00674 | $15K |
| CHUBB INSURANCE COMPANY OF PR EIN 66-0600740 NONE | Other services Service code 49 | PO BOX 191249 SAN JUAN, PR 00919 | $15K |
| DOCTORS CENTER HOSP SF CAROLINA EIN 66-0782101 NONE | Other services Service code 49 | PO BOX 30532 MANATI, PR 00674 | $15K |
| CENTRO CARDIOVASCULAR DE PR Y EL CA EIN 66-0437312 NONE | Other services Service code 49 | PO BOX 366528 SAN JUAN, PR 00936 | $10K |
| DOCTORS CENTER HOSPITAL MANATI EIN 66-0665951 NONE | Other services Service code 49 | PO BOX 30532 MANATI, PR 00674 | $9K |
| INFODATA EIN 58-3125796 NONE | Other services Service code 49 | PO BOX 193002 SAN JUAN, PR 00919 | $9K |
| HOSP UNIV DR R RUIZ ARNAU EIN 66-0437470 NONE | Other services Service code 49 | URB SANTA JUANITA 100 AVENIDA LAUREL BAYAMON, PR 00956 | $8K |
| DR DIEGO E MEJIAS FRANQUI EIN 58-4847210 NONE | Other services Service code 49 | MIRADOR DEL PARQUE TORRE I-1001 CALLE JUAN RODRIGUEZ SAN JUAN, PR 00921 | $8K |
| DR JOSE L ABRAMS FAJARDO EIN 58-3765149 NONE | Other services Service code 49 | 352 CALLE DEL PARQUE STE 202 SAN JUAN, PR 00912 | $8K |
| COOP SEGUROS DE VIDA DE PR EIN 66-0231517 NONE | Other services Service code 49 | PO BOX 363428 SAN JUAN, PR 00936 | $6K |
| DEL PARQUE INC EIN 66-0818474 NONE | Other services Service code 49 | LABORATORIO CLINICO PO BOX 8901 PMB 147 HATILLO, PR 00659 | $6K |
| DE DIEGO AMBULATORY CLINIC CORP EIN 66-0592682 NONE | Other services Service code 49 | SAN JUAN HEALTH CENTRE BLDG 150 AVE DE DIEGO BOX 1 SAN JUAN, PR 00919 | $6K |
| MANUEL R MARTINEZ JIRAU CPA EIN 58-1634904 NONE | Accounting (including auditing) Service code 10 | PO BOX 193653 SAN JUAN, PR 00919 | $6K |
| OVERSEAS INSURANCE AGENCY INC EIN 66-0357766 NONE | Other services Service code 49 | PO BOX 71467 SAN JUAN, PR 00936 | $5K |
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 | 1,175 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 1,175 | Active + retired/separated + beneficiaries. No dependents. |
No Schedule A insurance contracts on this filing — typical of fully self-funded plans, where the only headcount is the Form 5500 number above.
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."
Self-funded plan with no stop-loss carrier attached. Catastrophic-risk exposure; stop-loss specialist sales target.