| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AON CONSULTING INC3 Filed as: AON RISK SERVICES OF PR | — | TRIPLE S SALUD, INC. | $3K | — | $3K | 5.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HORIZON HEALTHCARE SERVICES, INC. EIN 22-0999690 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $1.3M |
| EXPRESS SCRIPTS, INC. EIN 43-1420563 CLAIMS PROCESSOR | Claims processing Service code 12 | — | $405K |
| LIFE INSURANCE COMPANY OF NORTH AME EIN 23-1503749 CONTRACT ADMINISTRATOR | Plan Administrator Service code 14 | — | $191K |
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 CLAIMS ADMINISTRATOR | Float revenue; Participant communication; Direct payment from the plan; Other services; Named fiduciary; Contract Administrator; Claims processing; Non-monetary compensation Service code 12 | — | $116K |
| SPECTERA, INC. EIN 52-1260282 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $39K |
| CIGNA | Other services Service code 49 | — | $0 |
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 | 9,308 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 236 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 9,544 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 515 | $1.7M |
| Vision | VISION SERVICE PLAN | 35 | $2K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 14,401 | $1.5M |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 9,265 | $1.7M |
| Other | LIFE INSURANCE COMPANY OF NORTH AMERICA | 12,649 | $248K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 14,401 | — |
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 comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.