| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT | 136 E SOUTH TEMPLE #2300 SALT LAKE CITY, UT 84111 | GUARDIAN | $12K | $1K | $13K | 6.32% |
| GBS BENEFITS INC3 Filed as: GBS BENEFITS, INC. | 525 EAST 100 S #200 SALT LAKE CITY, UT 84102 | GUARDIAN | $2K | — | $2K | 1.18% |
| ASSUREDPARTNERS3 Filed as: 136 E SOUTH TEMPLE STE 2300 | — | AMERITAS LIFE INSURANCE CORP. | $1K | — | $1K | 6.16% |
| 465 S 400 E STE 3003 | — | AMERITAS LIFE INSURANCE CORP. | $294 | — | $294 | 1.72% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| REGENCE BLUECROSS BLUESHIELD OF UTA EIN 87-0200138 CLAIMS PROCESSING SERVICE | Direct payment from the plan; Float revenue; Claims processing Service code 12 | — | $180K |
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 | 278 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 278 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | GUARDIAN | 278 | $203K |
| Vision | AMERITAS LIFE INSURANCE CORP. | 253 | $17K |
| Life insurance | GUARDIAN | 278 | $203K |
| Short-term disability | GUARDIAN | 278 | $203K |
| Long-term disability | GUARDIAN | 278 | $203K |
| Stop-loss / reinsurancereinsurance | SIRIUS AMERICA INSURANCE COMPANY | 187 | $359K |
| Other | GUARDIAN | 278 | $203K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 278 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.