| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS BENEFIT SVCS | 136 E SOUTH TEMPLE, STE 2300 SALT LAKE CITY, UT 84111 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $14K | $14K | 2.50% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENFIT | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $10K | $10K | 2.50% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SELECTHEALTH EIN 87-0409820 CONTRACT ADMINISTRATOR | Claims processing Service code 12 | — | $538K |
| REGENCE BLUECROSS BLUESHIELD OF UT EIN 87-0200138 CLAIMS PROCESSING | Contract Administrator; Direct payment from the plan; Non-monetary compensation; Claims processing; Insurance brokerage commissions and fees; Float revenue; Other services Service code 12 | — | $270K |
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 | 2,464 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,464 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SELECTHEALTH | 3,740 | $0 |
| Dental(2 contracts, 2 carriers) | DELTA DENTAL INSURANCE COMPANY | 4,876 | $0 |
| Vision | EYEMED | 3,433 | $173K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 2,464 | $560K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 2,464 | $560K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 2,464 | $560K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | UNITED STATES FIRE INSURANCE | 3,740 | $823K |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 2,464 | $1.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,876 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.