| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIVERSIDIED INS BENEFIT3 | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | REGENCE BLUECROSS BLUESHIELD OF UT | $32K | $5K | $37K | 7.44% |
| ADVANCED BENEFIT INC3 | 1299 W RIVERSTONE DR COEUR D ALENE, ID 83814 | REGENCE BLUECROSS BLUESHIELD OF UT | $6K | $6K | $11K | 2.27% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS BENEFIT | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | DENTISIT DIRECT, LLC | $3K | — | $3K | 4.00% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS BENEFIT | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | UNUM LIFE INS COMPANY OF AMERICA | $3K | $210 | $3K | 14.61% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS BENEFIT | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | UNUM LIFE INS COMPANY OF AMERICA | $3K | $172 | $3K | 14.30% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS BENEFIT | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | OPTICARE OF UTAH | $2K | — | $2K | 10.00% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS BENEFIT | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | UNUM LIFE INS COMPANY OF AMERICA | $2K | $100 | $2K | 15.92% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS BENEFIT | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | UNUM LIFE INS COMPANY OF AMERICA | $6K | — | $6K | 64.99% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS BENEFIT | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | UNUM LIFE INS COMPANY OF AMERICA | $433 | $45 | $478 | 10.06% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| REGENCE BLUECROSS EIN 87-0200138 CLAIMS PROCESSING | Claims processing; Float revenue; Direct payment from the plan Service code 12 | — | $61K |
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 | 129 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 129 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | REGENCE BLUECROSS BLUESHIELD OF UT | 255 | $495K |
| Dental | DENTISIT DIRECT, LLC | 123 | $63K |
| Vision | OPTICARE OF UTAH | 114 | $17K |
| Life insurance | UNUM LIFE INS COMPANY OF AMERICA | 129 | $5K |
| Short-term disability | UNUM LIFE INS COMPANY OF AMERICA | 31 | $11K |
| Long-term disability | UNUM LIFE INS COMPANY OF AMERICA | 48 | $20K |
| Other(3 contracts) | UNUM LIFE INS COMPANY OF AMERICA | 129 | $37K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 255 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.