| 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 | HARTFORD LIFE AND ACCIDENT | $8K | $0 | $8K | 10.78% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT SERVI | 136 E. S. TEMPLE #2300 SALT LAKE CITY, UT 84111 | AMERITAS LIFE INSURANCE CORP | $3K | $512 | $3K | 11.22% |
| 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 | $841 | $0 | $841 | 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 | $636 | $0 | $636 | 5.00% |
| DENISE ABBOTT4 | 2010 W 3211 S LOHAN, UT 84321 | PRE-PAID LEGAL SERVICES INC DBA LEGAL SHIELD | $815 | $0 | $815 | 27.57% |
| 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 | $132 | $0 | $132 | 5.02% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS BENEFIT SVCS | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | CIGNA DENTAL HEALTH OF FLORIDA, INC | $62 | $0 | $62 | 4.99% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS BENEFIT SVCS | 136 EAST SOUTH TEMPLE SUITE 2300 SALT LAKE CITY, UT 84111 | CIGNA DENTAL HEALTH OF VIRGINIA, INC | $44 | $0 | $44 | 5.02% |
| 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 | $44 | $0 | $44 | 5.02% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX,INC EIN 33-0441200 PHARMACY BENEFIT MANGMNT | Float revenue; Claims processing; Direct payment from the plan; Other fees Service code 12 | — | $431K |
| UMR, INC EIN 39-1995276 CLAIMS PROCESSOR | Claims processing Service code 12 | — | $64K |
| DIVERSIFIED INSURANCE GROUP EIN 20-4442550 BROKER | Other commissions Service code 55 | — | $50K |
| CIGNA BEHAVIORAL HEALTH, INC EIN 41-1648670 ADMINISTRATOR | Direct payment from the plan; Contract Administrator; Participant communication; Claims processing Service code 12 | — | $16K |
| OPTUMRX | Float revenue; Other fees; Claims processing; 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 | 771 | 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) | 771 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(6 contracts, 6 carriers) | CIGNA DENTAL HEALTH OF CALIFORNIA, INC | 19 | $35K |
| Vision | AMERITAS LIFE INSURANCE CORP | 448 | $30K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 771 | $78K |
| Stop-loss / reinsurancereinsurance(2 contracts) | SUN LIFE ASSURANCE COMPANY OF CANADA | 409 | $965K |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 771 | $81K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 771 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.