| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIVERSIFIED INSURANCE GROUP3 | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | UNITED HEALTHCARE INSURANCE COMPANY | — | $66K | $66K | 4.99% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS BENEFIT SERVICES | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $4K | — | $4K | 5.00% |
| AXA ASSISTANCE, USA5 Filed as: AXA ASSISTANCE USA | 122 S MICHIGAN AVE STE 1100 CHICAGO, IL 606036115 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $62 | $62 | 0.07% |
| DIVERSIFIED INSURANCE3 | 135 E SOUTH TEMPLE #2300 SALT LAKE CITY, UT 84111 | COMPANION LIFE INS CO GROUP DENTAL INDEMNITY PLAN | $6K | — | $6K | 6.77% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED BENEFIT SERVICE GROUP | 136 E SOUTH TEMPLE #2300 SALT LAKE CITY, UT 84111 | EYEMED VISION CARE | $2K | — | $2K | 9.88% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFITS | 136 E SOUTH TEMPLE #2300 SALT LAKE CITY, UT 84111 | TOTAL DENTAL ADMINISTRATORS OF UTAH, INC. | $887 | — | $887 | 6.90% |
No Schedule C service providers reported on this filing.
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 | 140 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 140 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITED HEALTHCARE INSURANCE COMPANY | 456 | $1.3M |
| Dental(2 contracts, 2 carriers) | COMPANION LIFE INS CO GROUP DENTAL INDEMNITY PLAN | 300 | $99K |
| Vision | EYEMED VISION CARE | 250 | $19K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 144 | $87K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 144 | $87K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 144 | $87K |
| Other | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 144 | $87K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 456 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.