| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIVERSIFIED INSURANCE GROUP3 | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | COMPANION LIFE INS CO. GROUP DENTAL INDEMNITY PLAN | $23K | — | $23K | 3.91% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS BENEFIT SERVICES | 136 E SOUTH TEMPLE #2300 SALT LAKE CITY, UT 84111 | THE LINCOLN NATIONAL LIFE INS COMPANY | $4K | $3K | $7K | 6.93% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS BENEFIT SERVICES | 136 E SOUTH TEMPLE #2300 SALT LAKE CITY, UT 84111 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $14K | $3K | $17K | 18.17% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS BENEFIT SERVICES | 136 E SOUTH TEMPLE #2300 SALT LAKE CITY, UT 84111 | THE LINCOLN NATIONAL LIFE INS COMPANY | $5K | $2K | $7K | 10.23% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS BENEFIT SERVICES | 136 E SOUTH TEMPLE #2300 SALT LAKE CITY, UT 84111 | THE LINCOLN NATIONAL LIFE INS COMPANY | $3K | $2K | $5K | 8.65% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| REGENCE BLUECROSS BLUESHIELD OF UT EIN 87-0200138 CLAIMS PROCESSING | Float revenue; Direct payment from the plan; Claims processing Service code 12 | — | $297K |
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 | 467 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 467 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | REGENCE BLUECROSS BLUESHIELD OF UTAH | 1,698 | $631K |
| Dental | COMPANION LIFE INS CO. GROUP DENTAL INDEMNITY PLAN | 453 | $593K |
| Vision | VISION SERVICE PLAN | 432 | $78K |
| Life insurance(2 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INS COMPANY | 507 | $193K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INS COMPANY | 507 | $70K |
| Other(2 contracts) | THE LINCOLN NATIONAL LIFE INS COMPANY | 507 | $159K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,698 | — |
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.