| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS. BENEFIT SERVICES | 136 EAST SOUTH TEMPLE STE. 2300 SALT LAKE CITY, UT 84111 | SELECTHEALTH | $41K | $14K | $54K | 2.20% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS. BENEFIT SERVICES | 136 EAST SOUTH TEMPLE STE. 2300 SALT LAKE CITY, UT 84111 | AMERITAS LIFE INSURANCE CORP | $6K | $3K | $9K | 2.65% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT | 136 E SOUTH TEMPLE SALT LAKE CITY, UT 84111 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $9K | $0 | $9K | 8.71% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT | 136 E SOUTH TEMPLE SALT LAKE CITY, UT 84111 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $0 | $5K | 15.00% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFITS | 136 EAST SOUTH TEMPLE SALT LAKE CITY, UT 84111 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $119 | $0 | $119 | 1.96% |
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 | 134 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 134 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SELECTHEALTH | 621 | $2.5M |
| Dental | AMERITAS LIFE INSURANCE CORP | 985 | $347K |
| Vision | AMERITAS LIFE INSURANCE CORP | 985 | $347K |
| Life insurance(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 309 | $145K |
| Short-term disability | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 26 | $6K |
| Long-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 309 | $111K |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 309 | $145K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 985 | — |
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.