| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFITS | 136 E. SOUTH TEMPLE #2300 SALT LAKE, UT 84111 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $5K | $0 | $5K | 10.66% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $2K | $2K | 4.27% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFITS | 136 E. SOUTH TEMPLE #2300 SALT LAKE, UT 84111 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $0 | $3K | 10.67% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $1K | $1K | 4.27% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFITS | 136 E. SOUTH TEMPLE #2300 SALT LAKE, UT 84111 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | $0 | $3K | 10.68% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN RD. SOLON, OH 44139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $0 | $1K | $1K | 4.27% |
| NATIONAL BENEFIT CENTER3 | 6830 COCHRAN ROAD SOLON, OH 44139 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $286 | $474 | $760 | 17.34% |
| DIVERSIFIED INSURANCE GROUP3 | 136 E SOUTH TEMPLE SALT LAKE CITY, UT 84111 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $469 | $0 | $469 | 10.70% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UMR, INC EIN 39-1995276 CLAIMS PROCESSING | Claims processing Service code 12 | — | $225K |
| DIVERSIFIED INSURANCE BENEFIT SERVI BROKER | Other commissions Service code 55 | 136 E SOUTH TEMPLE #2300 SALT LAKE CITY, UT 84111 | $99K |
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 BROKER | Participant communication; Claims processing Service code 12 | — | $36K |
| CIGNA HEALTH & LIFE INS CO | Contract Administrator; Other services; Float revenue; Claims processing; Non-monetary compensation; Named fiduciary; Participant communication; Direct payment from the plan Service code 12 | — | $0 |
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 | 249 | 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) | 249 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | HCC LIFE INSURANCE COMAPNY | 245 | $592K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $27K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $29K |
| Stop-loss / reinsurancereinsurance | TOKIO MARINE | 249 | $592K |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 0 | $55K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 249 | — |
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."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.