Form 5500 · Employee benefit plan · GUAYNABO
GLAXOSMITHKLINE PUERTO RICO INC.
The filing calls this plan GLAXOSMITHKLINE HEALTH AND WELFARE BENEFITS PLAN FOR PUERTO RICO EMPLOYEES.
GLAXOSMITHKLINE PUERTO RICO INC. of GUAYNABO, PR spreads its employee benefits across 5 insurance carriers, according to its Form 5500 Schedule A. Its broker of record is MERCER HEALTH & BENEFITS LLC. Coverage is written through AETNA LIFE INSURANCE COMPANY and 4 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 66-0613421 · plan 554 · plan year 2025, filed Sep 14, 2026
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How this plan is funded
Both, as reported
The medical insurance contracts on the filing cover fewer than half the people in the plan, so the rest is paid another way.
A stop-loss policy appears on a Form 5500 only when the plan itself is the beneficiary, or the premiums are paid from plan money. Many employers buy stop-loss and never report it here. So a plan with no stop-loss on its filing may still have it.
Benefits declared on this filing
One contract on this filing does not say which benefits it covers, so a line above may be insured by it.
Also declared: severance.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 5 insured contracts covering health, vision, life, disability and stop-loss.
The filing declares health, vision, life, disability and dental. Dental appears with no insured contract on Schedule A. That coverage may be self-funded, placed with a carrier that is not on this filing, or written on the contract here that does not say what it covers.
The medical plan carries stop-loss coverage: the filing reports the plan paying its own health claims, with insured protection against large ones.
Reported premium is $2,328,936; the filing discloses no broker commission on these contracts.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY | Health | 57 | Jan 1, 2026 | $1,697,142 | $0 |
| TRIPLE S ADVANTAGE | — | 254 | Jan 1, 2026 | $550,800 | $0 |
| TRIPLE S SALUD, INC. | Stop-loss | 82 | Jan 1, 2026 | $64,034 | $0 |
| HARTFORD LIFE AND ACCIDENT | Life, Disability | 288 | Jan 1, 2026 | $16,476 | $0 |
| EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | Vision | 0 | Jan 1, 2026 | $484 | $0 |
Premium and claims on this contract
AETNA LIFE INSURANCE COMPANY, contract 0331791. For the contract year on this filing, the carrier reported $1,697,142 in premium earned and $1,813,722 in claims incurred. Dividing one by the other gives 107%.
- AETNA LIFE INSURANCE COMPANY, contract 0331791 reported $261,570 in retention.
Retention is what the carrier kept of the premium after claims, as reported: administration, commissions and other charges.
Only experience-rated contracts report these figures, so most filings leave them blank.
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Other plans filed by this employer
How this plan compares
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