Form 5500 · Employee benefit plan · CAROLINA
LILLY DEL CARIBE, INC.
The filing calls this plan THE ELI LILLY PUERTO RICO EMPLOYEE WELFARE PLAN.
Public Form 5500 records show how LILLY DEL CARIBE, INC. of CAROLINA, PR, a manufacturing employer, structures its employee benefits. Its broker of record is HUB INTERNATIONAL PUERTO RICO, INC.. Coverage is written through TRIPLE S ADVANTAGE and 5 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 98-0167031 · plan 508 · plan year 2024, filed Oct 7, 2025
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189 other employer plans in the U.S. have policy years ending in December. See the full list on the renewal calendar, or ask for it in Claude or ChatGPT.
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
Also declared: death benefits, other welfare.
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.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
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 6 insured contracts covering health, dental, vision, life and disability; the largest, with TRIPLE S ADVANTAGE, covers 664 people.
Reported premium across the insured contracts is $2,227,905, with $74,467 in disclosed broker commissions — about 3.3% of premium.
The health contract's policy period ended in December, while at least one ancillary line's policy period ended in August. The plan is on a split renewal cycle.
HUB INTERNATIONAL PUERTO RICO, INC. is the broker of record on 2 of the 6 contracts; the rest name a different broker or none.
6 carriers appear on the filing, including TRIPLE S ADVANTAGE, METROPOLITAN LIFE INSURANCE COMPANY, TRIPLE S SALUD, INC. and PRUDENTIAL INSURANCE COMPANY OF AMERICA. TRIPLE S ADVANTAGE writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| METROPOLITAN LIFE INSURANCE COMPANY | Life | 1,477 | Jan 1, 2025 | $501,059 | $61,397 |
| TRIPLE-S VIDA, INC. | — | 1,100 | Jan 1, 2025 | $63,455 | $12,691 |
| ACE AMERICAN INSURANCE COMPANY | — | 1,059 | Sep 1, 2024 | $1,843 | $379 |
| TRIPLE S ADVANTAGE | Health, Dental, Vision | 664 | Jan 1, 2025 | $1,241,916 | $0 |
| TRIPLE S SALUD, INC. | Health, Dental, Vision | 40 | Jan 1, 2025 | $332,624 | $0 |
| PRUDENTIAL INSURANCE COMPANY OF AMERICA | Disability | 1,066 | Jan 1, 2025 | $87,008 | $0 |
Premium and claims on this contract
TRIPLE S SALUD, INC., contract SP0004002. For the contract year on this filing, the carrier reported $332,624 in premium earned and $407,653 in claims incurred. Dividing one by the other gives 123%.
- TRIPLE S SALUD, INC., contract SP0004002 reported $0 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.
Reported to OSHA
Reported to OSHA for 2025: 1,165 employees, 11 recordable cases, 113 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
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Renewal calendar
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