Form 5500 · Employee benefit plan · SAN JUAN
SISTEMA UNIVERSITARIO ANA G MENDEZ
The filing calls this plan SISTEMA UNIVERSITARIO ANA G MENDEZ OBSERVATORIO DE ARECIBO.
SISTEMA UNIVERSITARIO ANA G MENDEZ of SAN JUAN, PR is a small professional services employer whose insured group plan is on public record in its Form 5500 filing. Its broker of record is CGF INSURANCE LLC. Coverage is written through TRIPLE S SALUD, INC.. The plan's most recent policy period ended in September.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 66-0201206 · plan 504 · plan year 2023, filed Apr 15, 2024
Get an email when this employer files a new Form 5500, and again about four months before its plan renews.
How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
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 1 insured contract covering health and dental.
Reported premium across the insured contracts is $15,754, with $780 in disclosed broker commissions — about 5% of premium.
The most recent policy period ended in September, and the plan year ends September 30. Group contracts typically renew on that annual cycle.
At 11 participants this is a small group; Form 5500 is required once a welfare plan reaches 100 participants, or when it is funded through insurance contracts.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| TRIPLE S SALUD, INC. | Health, Dental | 0 | Oct 1, 2023 | $15,754 | $780 |
Premium and claims on this contract
TRIPLE S SALUD, INC., contract SP-0004481. For the contract year on this filing, the carrier reported $15,754 in premium earned and $23,468 in claims incurred. Dividing one by the other gives 149%.
- TRIPLE S SALUD, INC., contract SP-0004481 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.
Reported to OSHA
Reported to OSHA for 2025: 3,903 employees, 41 recordable cases, 361 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
How this plan compares
Subscribers see how this compares with similar plans in this state. A subscription also adds this plan's filing history and the renewal calendar for its state. See plans and prices
Without an account you can open 10 employer, broker and carrier pages a day, including through an AI assistant, and 50 a day with a free account. Paid plans are what keep these records free to read.