| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT | 136 E SOUTH TEMPLE SALT LAKE CITY, UT 84111 | UNUM LIFE INSURANCE CO. OF AMERICA | $19K | $15K | $34K | 5.63% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT | 136 E SOUTH TEMPLE SALT LAKE CITY, UT 84111 | UNUM LIFE INSURANCE CO. OF AMERICA | $8K | $7K | $15K | 4.10% |
| DIVERSIFIED INSURANCE GROUP Filed as: DIVERSIFIED INSURANCE BENEFIT SERVI | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | AMERITAS LIFE INSURANCE CORP | $7K | $1K | $8K | 3.66% |
| DIVERSIFIED INSURANCE | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | TOTAL DENTAL ADMINISTRATORS OF UTAH, INC. | $2K | — | $2K | 7.68% |
| DIVERSIFIED INSURANCE | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | COMPANION LIFE INS CO GROUP DENTAL INDEMNITY PLAN | $2K | — | $2K | 7.77% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT | 136 E SOUTH TEMPLE SALT LAKE CITY, UT 84111 | FIRST UNUM LIFE INSURANCE COMPANY | — | $17 | $17 | 2.45% |
| DIVERSIFIED INSURANCE GROUP Filed as: DIVERSIFIED INSURANCE BENEFIT | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | SELECTHEALTH | — | — | $0 | — |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT SERVI | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | CONNNECTICUT GENERAL LIFE INSURANCE COMPANY (CIGNA) | $92K | — | $92K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SELECTHEALTH EIN 87-0409820 CONTRACT ADMINISTRATOR | Claims processing Service code 12 | — | $755K |
| CONNECTICUT GENERAL LIFE INS(CIGNA) EIN 59-1031071 CLAIM ADMINISTRATION | Other services; Participant communication; Direct payment from the plan; Claims processing; Non-monetary compensation; Float revenue; Named fiduciary; Contract Administrator Service code 12 | — | $379K |
| REGENCE BLUECROSS BLUESHIELD OF UT EIN 87-0200138 CLAIMS PROCESSING SERVICE | Claims processing; Float revenue; Direct payment from the plan Service code 12 | — | $112K |
| UNUM LIFE INSURANCE COMPANY OF AMER EIN 01-0278678 PLAN ADMINISTRATOR | Plan Administrator Service code 14 | — | $46K |
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 | 1,949 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 26 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 1,975 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | SELECTHEALTH | 2,945 | $0 |
| Dental(4 contracts, 4 carriers) | TOTAL DENTAL ADMINISTRATORS OF UTAH, INC. | 4,166 | $55K |
| Vision(2 contracts, 2 carriers) | AMERITAS LIFE INSURANCE CORP | 2,395 | $217K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE CO. OF AMERICA | 2,302 | $985K |
| Short-term disability(2 contracts) | UNUM LIFE INSURANCE CO. OF AMERICA | 2,302 | $985K |
| Long-term disability(2 contracts, 2 carriers) | UNUM LIFE INSURANCE CO. OF AMERICA | 2,302 | $374K |
| Stop-loss / reinsurancereinsurance | SELECTHEALTH | 2,945 | $0 |
| Other | AMERITAS LIFE INSURANCE CORP | 2,395 | $217K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,166 | — |
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.