| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STEALTH PARTNER GROUP LLC3 Filed as: STEALTH PARTNER GROUP | — | BERKLEY LIFE AND HEALTH INSURANCE CO | $38K | — | $38K | 5.00% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS BENEFIT | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | METROPOLITAN LIFE INSURANCE COMPANY | $14K | $6K | $20K | 2.96% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT | 136 E SOUTH TEMPLE SALT LAKE CITY, UT 84111 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $7K | $12K | 4.04% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | AMERITAS LIFE INSURANCE CORP | $13K | $1K | $14K | 10.80% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT | 136 E SOUTH TEMPLE SALT LAKE CITY, UT 84111 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $3K | $8K | 6.46% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS BENEFIT SERVICES | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | SELECTHEALTH | $39K | — | $39K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY EIN 06-6033492 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $241K |
| SELECTHEALTH EIN 87-0409820 CONTRACT ADMINISTRATOR | Claims processing Service code 12 | — | $203K |
| UNUM LIFE INSURANCE CO OF AMERICA EIN 01-0278678 ADMINISTRATIVE SERVICE | Claims processing Service code 12 | — | $7K |
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 | 507 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 507 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SELECTHEALTH | 847 | $0 |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 2,070 | $686K |
| Vision | AMERITAS LIFE INSURANCE CORP | 480 | $134K |
| Life insurance(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 2,070 | $979K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 516 | $293K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 516 | $128K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,070 | — |
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."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.