| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| LUIS R. SOLER VAZQUEZ Filed as: LUIS R. SOLER-VAZQUEZ | 1219 MAGDALENA AVENUE APT. 405 SAN JUAN, PR 00907 | FIRST MEDICAL HEALTH PLAN, INC. | $0 | $7K | $7K | 4.64% |
| OWNER'S RISK INSURANCE MANAGEMENT Filed as: OWNER'S RISK INSURANCE MGMT., INC. | PO BOX 191730 SAN JUAN, PR 00919 | FIRST MEDICAL HEALTH PLAN, INC. | $0 | $4K | $4K | 4.96% |
| JESUS M. ROSARIO NARVAEZ Filed as: JESUS M. ROSARIO-NARVAEZ | COND. PARQUE DE LA VISTA 1280 CALLE JUAN BAIZ APT. 330-C SANJUAN, PR 00924 | FIRST MEDICAL HEALTH PLAN, INC. | $0 | $4K | $4K | 4.97% |
| JESUS M. ROSARIO NARVAEZ3 Filed as: JESUS M. ROSARIO-NARVAEZ | COND. PARQUE DE LA VISTA I 1280 CALLE JUAN BAIZ APT. 330-C SAN JUAN, PR 00924 | DELTA DENTAL OF PUERTO RICO, INC. | $3K | $0 | $3K | 3.50% |
| LUIS R. SOLER VAZQUEZ3 Filed as: LUIS R. SOLER-VAZQUEZ | 1219 MARGALENA AVENUE APT. 405 SAN JUAN, PR 00907 | DELTA DENTAL OF PUERTO RICO, INC. | $3K | $0 | $3K | 3.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| MCS LIFE INSURANCE COMPANY EIN 66-0520918 NONE | Other services Service code 49 | PO BOX 193310 SAN JUAN, PR 00919 | $370K |
| FIRST MEDICAL HEALTH PLAN, INC. EIN 66-0537624 NONE | Other services Service code 49 | PO BOX 70264 SAN JUAN, PR 00936 | $297K |
| TRIPLE-S SALUD EIN 66-0555677 NONE | Other services Service code 49 | PO BOX 71548 SAN JUAN, PR 00936 | $153K |
| 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 | $73K |
| EFRAIN SOTO DE JESUS EIN 58-3548158 EMPLOYEE | Employee (plan) Service code 30 | URB SANTA JUANITA D65 CALLE ESPANA BAYAMON, PR 00956 | $53K |
| DOCTORS CENTER HOSP. BAYAMON EIN 66-0265947 NONE | Other services Service code 49 | PO BOX 30532 MANATI, PR 00674 | $45K |
| DOCTORS CENTER HOSP. SAN JUAN EIN 66-0686840 NONE | Other services Service code 49 | PO BOX 30532 MANATI, PR 00674 | $38K |
| AIDA L ORTIZ RODRIGUEZ EIN 58-1415086 EMPLOYEE | Employee (plan) Service code 30 | URB SUMMIT HILLS 562 CALLE TORRECILLA 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 | $32K |
| LCDO. JOSE E. CARRERAS ROVIRA EIN 58-4109164 LEGAL ADVISOR | Legal Service code 29 | 352 CALLE DEL PARQUE SAN JUAN, PR 00912 | $26K |
| AMERICAN HERITAGE LIFE INS. CO. EIN 59-0781901 NONE | Other services Service code 49 | PO BOX 650514 DALLAS, TX 75265 | $20K |
| VICTOR M ORTEGA RAMON EIN 58-4205792 EMPLOYEE | Employee (plan) Service code 30 | URB VILLA BORINQUEN 405 CALLE DUERO SAN JUAN, PR 00920 | $19K |
| HOSPITAL WILMA N. VAZQUEZ EIN 66-0403210 NONE | Other services Service code 49 | PO BOX 7001 VEGA BAJA, PR 00694 | $19K |
| DOCTORS CENTER HOSP. MANATI EIN 66-0665951 NONE | Other services Service code 49 | PO BOX 30532 MANATI, PR 00674 | $16K |
| JOSE OQUENDO DAVILA EIN 58-2379191 NONE | Other services Service code 49 | 2449 CALLE SANTA ELENA CANTERA SAN JUAN, PR 00915 | $13K |
| DR. JESUS VELEZ FELICIANO EIN 58-4761819 NONE | Other services Service code 49 | VILLAS DE LEVITTOWN A-19 CALLE 1 TOA BAJA, PR 00949 | $12K |
| LIBERTY MUTUAL INSURANCE CO. EIN 04-1543470 NONE | Other services Service code 49 | 304 AVE. PONCE DE LEON SUITE 903 SAN JUAN, PR 00918 | $10K |
| DOCTORS CENTER HOSP. S.F. CAROLINA EIN 66-0782101 NONE | Other services Service code 49 | PO BOX 30532 MANATI, PR 00674 | $8K |
| CHUBB INSURANCE COMPANY OF PR EIN 66-0600740 NONE | Other services Service code 49 | PO BOX 191249 SAN JUAN, PR 00919 | $6K |
| OVIDIO RUIZ HERNANDEZ EIN 58-3518920 NONE | Legal Service code 29 | PO BOX 3266 CAROLINA, PR 00984 | $6K |
| ROSA M VELEZ AVILES EIN 58-3208260 EMPLOYEE | Employee (plan) Service code 30 | URB LA INMACULADA G-3 CALLE CRUZ TOA BAJA, PR 00949 | $6K |
| DEL PARQUE INC. LABORATORIO CLINICO EIN 66-0818474 NONE | Other services Service code 49 | PO BOX 8901 PMB 147 HATILLO, PR 00659 | $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 | 799 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 799 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts) | FIRST MEDICAL HEALTH PLAN, INC. | 41 | $326K |
| Dental(2 contracts, 2 carriers) | FIRST MEDICAL HEALTH PLAN, INC. | 246 | $163K |
| Vision(2 contracts) | FIRST MEDICAL HEALTH PLAN, INC. | 41 | $240K |
| Life insurance(2 contracts) | FIRST MEDICAL HEALTH PLAN, INC. | 39 | $175K |
| Prescription drug(3 contracts) | FIRST MEDICAL HEALTH PLAN, INC. | 41 | $326K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 246 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.