| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT SERVI | 136 E SOUTH TEMPLE SUITE 2300 SALT LAKE CITY, UT 84111 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | $2K | $8K | — |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT SERVI | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | UNITEDHEALTHCARE INSURANCE COMPANY | $0 | $76K | $76K | — |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT SERVI | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | $0 | $1K | — |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $374 | $374 | — |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT SERVI | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $5K | $0 | $5K | — |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD SOLON, OH 44139 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $0 | $1K | $1K | — |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT SERVI | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | $0 | $2K | — |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT SERVI | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $4K | $0 | $4K | — |
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 | 163 | 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. |
| Beneficiaries receiving benefits | 0 | Spouses or dependents with eligibility independent of the participant. |
| Total participants (= "Plan participants" tile) | 163 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | UNITEDHEALTHCARE INSURANCE COMPANY | 328 | $0 |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 406 | $0 |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 406 | $0 |
| Life insurance | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 433 | $0 |
| Short-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 163 | $0 |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 163 | $0 |
| Other(2 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 433 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 433 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.