| 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 | LIFEMAP ASSURANCE COMPANY | $29K | — | $29K | 15.47% |
| 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 | $2K | $946 | $3K | 28.17% |
| HIGH POINT ALLIANCE4 | 1119 E BIRCHBROOK CIR COTTONWOOD HEIGHTS, UT 84047 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $282 | — | $282 | 9.19% |
| RALPH B WRIGHT4 | 835 EAST 700 SOUTH BOUNTIFUL, UT 84010 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $70 | — | $70 | 2.28% |
| GBS BENEFITS INC4 | 465 SOUTH 400 EAST SUTE 300 SALT LAKE CITY, UT 84111 | PRE-PAID LEGAL SERVICES, INC. DBA LEGALSHIELD | $69 | — | $69 | 2.25% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| REGENCE BLUECROSS BLUESHIELD OF UTA EIN 87-0200138 CLAIMS PROCESSING SERVICE | Non-monetary compensation; Claims processing; Insurance brokerage commissions and fees; Contract Administrator; Direct payment from the plan; Other services; Float revenue Service code 12 | — | $160K |
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 | 239 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 239 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | COMMENCEMENT BAY RISK MANAGEMENT INSURANCE COMPANY | 581 | $371K |
| Dental | SELECT BENEFITS GROUP INC., DBA DENTAL SELECT | 192 | $0 |
| Vision | OPTICARE OF UTAH | 109 | $16K |
| Life insurance | LIFEMAP ASSURANCE COMPANY | 239 | $187K |
| Short-term disability | LIFEMAP ASSURANCE COMPANY | 239 | $187K |
| Long-term disability | LIFEMAP ASSURANCE COMPANY | 239 | $187K |
| Stop-loss / reinsurancereinsurance | COMMENCEMENT BAY RISK MANAGEMENT INSURANCE COMPANY | 581 | $371K |
| Other(3 contracts, 3 carriers) | LIFEMAP ASSURANCE COMPANY | 239 | $202K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 581 | — |
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.