| 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 | $3K | $7K | $10K | 2.03% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT | 136 E SOUTH TEMPLE SALT LAKE CITY, UT 84111 | UNUM LIFE INSURANCE CO. OF AMERICA | $14K | $7K | $21K | 4.44% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT SERVI | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | AMERITAS LIFE INSURANCE CORP | $8K | $1K | $9K | 3.42% |
| 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) | $61K | — | $61K | 60.55% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT | 136 E SOUTH TEMPLE SALT LAKE CITY, UT 84111 | FIRST UNUM LIFE INSURANCE COMPANY | — | $7 | $7 | 1.22% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | SELECTHEALTH | — | — | $0 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| SELECTHEALTH EIN 87-0409820 CONTRACT ADMINISTRATOR | Claims processing Service code 12 | — | $683K |
| CONNECTICUT GENERAL LIFE INS(CIGNA) EIN 59-1031071 CLAIM ADMINISTRATION | Other services; Named fiduciary; Float revenue; Claims processing; Participant communication; Contract Administrator; Direct payment from the plan; Non-monetary compensation Service code 12 | — | $528K |
| UNUM LIFE INSURANCE COMPANY OF AMER EIN 01-0278678 PLAN ADMINISTRATOR | Plan Administrator Service code 14 | — | $42K |
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 | 2,058 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 26 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 2,084 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SELECTHEALTH | 2,821 | $0 |
| Dental(2 contracts, 2 carriers) | CONNNECTICUT GENERAL LIFE INSURANCE COMPANY (CIGNA) | 2,821 | $100K |
| Vision | AMERITAS LIFE INSURANCE CORP | 2,470 | $257K |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE CO. OF AMERICA | 2,450 | $975K |
| Short-term disability(2 contracts) | UNUM LIFE INSURANCE CO. OF AMERICA | 2,450 | $975K |
| Long-term disability(3 contracts, 2 carriers) | UNUM LIFE INSURANCE CO. OF AMERICA | 2,450 | $508K |
| Stop-loss / reinsurancereinsurance | SELECTHEALTH | 2,821 | $0 |
| Other(2 contracts, 2 carriers) | AMERITAS LIFE INSURANCE CORP | 2,470 | $357K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,821 | — |
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.