| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT SVCS | 136E SOUTH TEMPLE SALT LAKE CITY, UT 84111 | AETNA LIFE INSURANCE COMPANY | $114K | $0 | $114K | 3.94% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT SVCS | 93 SOUTH STATE ST SALT LAKE CITY, UT 84111 | AETNA LIFE INSURANCE COMPANY | $15K | $0 | $15K | 0.51% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT SVCS | 136E SOUTH TEMPLE SALT LAKE CITY, UT 84111 | AETNA HEALTH, INC. | $10K | $0 | $10K | 3.79% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT SVCS | 93 SOUTH STATE ST SALT LAKE CITY, UT 84111 | AETNA HEALTH, INC. | $736 | $0 | $736 | 0.27% |
| IMA, INC.3 Filed as: IMA INC | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | HARTFORD LIFE & ACCIDENT | $6K | $532 | $6K | 16.05% |
| ACRISURE LLC3 | 100 OTTAWA AVE SW GRAND RAPIDS, MI 49503 | HARTFORD LIFE & ACCIDENT | $0 | $11 | $11 | 0.03% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 23716 BIRTCHER DR LAKE FOREST, CA 92630 | HARTFORD LIFE & ACCIDENT | -$15 | $0 | -$15 | -0.04% |
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 | 533 | 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) | 533 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | AETNA LIFE INSURANCE COMPANY | 429 | $2.9M |
| Dental | AETNA LIFE INSURANCE COMPANY | 429 | $2.9M |
| Vision | AETNA LIFE INSURANCE COMPANY | 429 | $2.9M |
| Life insurance | HARTFORD LIFE & ACCIDENT | 533 | $40K |
| Other | HARTFORD LIFE & ACCIDENT | 533 | $40K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 533 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.