| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS BENEFIT SVCS | 136 EAST SOUTH TEMPLE SUITE 2300 SALT LAKE CITY, UT 84111 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $8K | $5K | $13K | 8.14% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS BENEFIT SVCS | 136 EAST SOUTH TEMPLE SUITE 2300 SALT LAKE CITY, UT 84111 | HARTFORD LIFE AND ACCIDENT | $7K | $751 | $8K | 11.04% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT SERVI | 136 E. S. TEMPLE #2300 SALT LAKE CITY, UT 84111 | AMERITAS LIFE INSURANCE CORP | $3K | $440 | $3K | 11.12% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS BENEFIT SVCS | 136 EAST SOUTH TEMPLE SUITE 2300 SALT LAKE CITY, UT 84111 | CIGNA DENTAL HEALTH OF CALIFORNIA, INC | $982 | $0 | $982 | 5.00% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS BENEFIT SVCS | 136 EAST SOUTH TEMPLE SUITE 2300 SALT LAKE CITY, UT 84111 | CIGNA DENTAL HEALTH PLAN OF ARIZONA, INC | $611 | $0 | $611 | 5.00% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS BENEFIT SVCS | 136 EAST SOUTH TEMPLE SUITE 2300 SALT LAKE CITY, UT 84111 | CIGNA DENTAL HEALTH OF COLORADO, INC | $175 | $0 | $175 | 5.01% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS BENEFIT SVCS | 136 EAST SOUTH TEMPLE SUITE 2300 SALT LAKE CITY, UT 84111 | CIGNA DENTAL HEALTH OF KENTUCKY, INC | $65 | $0 | $65 | 4.96% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS BENEFIT SVCS | — | CIGNA DENTAL HEALTH OF FLORIDA, INC | $16 | $0 | $16 | 4.89% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS BENEFIT SVCS | 136 EAST SOUTH TEMPLE SUITE 2300 SALT LAKE CITY, UT 84111 | CIGNA DENTAL HEALTH OF TEXAS, INC | $11 | $0 | $11 | 5.05% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS BENEFIT SVCS | 136 EAST SOUTH TEMPLE SUITE 2300 SALT LAKE CITY, UT 84111 | CIGNA DENTAL HEALTH OF MISSOURI, INC | $5 | $0 | $5 | 4.59% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| UNITED HEALTHCARE SERVICES INC. EIN 41-1289245 CLAIMS PROCESSOR | Claims processing; Other services Service code 12 | — | $200K |
| CIGNA BEHAVIORAL HEALTH, INC EIN 41-1648670 ADMINISTRATOR | Participant communication; Claims processing; Contract Administrator; Direct payment from the plan Service code 12 | — | $15K |
| DIVERSIFIED INSURANCE GROUP EIN 20-4442550 BROKER | Other commissions Service code 55 | — | $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 | 764 | 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) | 764 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(8 contracts, 8 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 375 | $194K |
| Vision | AMERITAS LIFE INSURANCE CORP | 484 | $27K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 764 | $72K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 415 | $400K |
| Other | HARTFORD LIFE AND ACCIDENT | 764 | $72K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 764 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.