| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS BENEFIT SERVICES | 136 EAST SOUTH TEMPLE SALT LAKE CITY, UT 84111 | PRUDENTIAL INSURANCE COMPANY | $83K | — | $83K | 5.33% |
| STHEALTH BENEFIT SOLUTIONS LLC3 | 18940 NORTH PIMA ROAD,STE 210 SCOTTSDALE, AZ 85255 | UNIMERICA INSURANCE COMPANY | $23K | — | $23K | 2.38% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT SERVI | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | AMERITAS LIFE INSURANCE CORP | $5K | $2K | $6K | 2.14% |
| 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) | $4K | — | $4K | 2.96% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | SELECTHEALTH | $101K | — | $101K | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| 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 | — | $934K |
| SELECTHEALTH EIN 87-0409820 CONTRACT ADMINISTRATOR | Claims processing Service code 12 | — | $795K |
| PRUDENTIAL INSURANCE COMPANY EIN 22-1211670 PLAN ADMINISTRATOR | Plan Administrator Service code 14 | — | $57K |
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 | 2,127 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 17 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 2,144 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNIMERICA INSURANCE COMPANY | 3,101 | $985K |
| Dental(2 contracts, 2 carriers) | CONNNECTICUT GENERAL LIFE INSURANCE COMPANY (CIGNA) | 3,101 | $125K |
| Vision | AMERITAS LIFE INSURANCE CORP | 2,622 | $303K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY | 4,077 | $1.6M |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY | 4,077 | $1.6M |
| Prescription drug | CONNNECTICUT GENERAL LIFE INSURANCE COMPANY (CIGNA) | 889 | $125K |
| Stop-loss / reinsurancereinsurance | SELECTHEALTH | 3,101 | $0 |
| Other(3 contracts, 3 carriers) | PRUDENTIAL INSURANCE COMPANY | 4,077 | $2.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,077 | — |
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.