| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STEALTH PARTNER GROUP LLC3 Filed as: STEALTH BENEFIT SOLUTIONS, LLC | 18940 NORTH PIMA RD STE 210 SCOTTSDALE, AZ 85260 | SYMETRA LIFE INSURANCE COMPANY | — | $19K | $19K | 4.34% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFITS SERV | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 841111117 | PRINCIPAL LIFE INSURANCE COMPANY | $13K | $8K | $21K | 5.68% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT | 136 E SOUTH TEMPLE SALT LAKE CITY, UT 84111 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $0 | $0 | 0.00% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT | 136 E SOUTH TEMPLE SALT LAKE CITY, UT 84111 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $0 | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES, INC EIN 41-1289245 CLAIMS PROCESSOR | Other services; Claims processing Service code 12 | — | $424K |
| DIVERSIFIED INSRANCE GROUP EIN 20-4442550 BROKER | Other commissions Service code 55 | — | $0 |
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 | 625 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 625 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 1,571 | $363K |
| Vision | PRINCIPAL LIFE INSURANCE COMPANY | 1,571 | $363K |
| Life insurance(3 contracts, 2 carriers) | SYMETRA LIFE INSURANCE COMPANY | 689 | $542K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 689 | $87K |
| Other(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 689 | $114K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,571 | — |
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.