| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: FULCRO INSURANCE | PO BOX 9024048 SAN JUAN, PR 009024048 | TRIPLE S SALUD INC | $65K | — | $65K | 2.75% |
| ACRISURE LLC3 Filed as: FULCRO INSURANCE INC | PO BOX 9024408 SAN JUAN, PR 00901 | HARTFORD LIFE AND ACCIDENT | $31K | — | $31K | 20.90% |
| INNOVA INSURANCE3 Filed as: INNOVA INSURANCE SERVICES INC | PMB 234 AVE ESMERALDA 405 STE 2 GUAYNABO, PR 009694427 | HARTFORD LIFE AND ACCIDENT | — | $8K | $8K | 5.23% |
| ACRISURE LLC3 Filed as: FULCRO INSURANCE | PO BOX 9024048 SAN JUAN, PR 009024048 | DELTA DENTAL OF PUERTO RICO, INC. | $6K | — | $6K | 6.00% |
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 | 749 | 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) | 749 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | TRIPLE S SALUD INC | 695 | $2.3M |
| Dental | DELTA DENTAL OF PUERTO RICO, INC. | 720 | $97K |
| Life insurance(2 contracts, 2 carriers) | TRIPLE S SALUD INC | 749 | $2.5M |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 749 | $148K |
| Prescription drug | TRIPLE S SALUD INC | 695 | $2.3M |
| Other(2 contracts, 2 carriers) | TRIPLE S SALUD INC | 749 | $2.5M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 749 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.