| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS BENEFIT | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $19K | — | $19K | 7.81% |
| AXA ASSISTANCE, USA5 | 122 S MICHIGAN AVE STE 1100 CHICAGO, IL 60603 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $125 | $125 | 0.05% |
| DIVERSIFIED INSURANCE GROUP3 | 136 EAST SOUTH TEMPLE #2300 SALT LAKE CITY, UT 84111 | OPTICARE OF UTAH | $2K | — | $2K | 10.00% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT | 136 E SOUTH TEMPLE #2300 SALT LAKE CITY, UT 84111 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $3K | $248 | $4K | 21.45% |
| NATIONAL BENEFIT CENTER3 | 1105 N MARKET ST STE 1300 WILMINGTON, DE 19801 | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $12 | — | $12 | 0.07% |
| RALPH B WRIGHT4 | 835 EAST 700 SOUTH BOUNTIFUL, UT 84010 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $545 | — | $545 | 8.38% |
| HIGH POINT ALLIANCE4 | 1119 E BIRCHBROOK CIR COTTONWOOD HEIGHTS, UT 84047 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $420 | — | $420 | 6.46% |
| GBS BENEFITS INC4 | 465 SOUTH 400 EAST SUTE 300 SALT LAKE CITY, UT 84111 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $94 | — | $94 | 1.45% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| REGENCE BLUECROSS BLUESHIELD OF UTA EIN 87-0200138 CLAIMS PROCESSING SERVICE | Float revenue; Direct payment from the plan; Claims processing Service code 12 | — | $147K |
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 | 312 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 312 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | REGENCE BLUECROSS BLUESHIELD OF UTAH | 733 | $467K |
| Dental | SELECT BENEFITS GROUP INC., DBA DENTAL SELECT | 255 | $0 |
| Vision | OPTICARE OF UTAH | 144 | $19K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 312 | $240K |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 312 | $240K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 312 | $240K |
| Other(3 contracts, 3 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 312 | $264K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 733 | — |
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."
No prospect flags tripped on this filing.