| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT | 136 EAST SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $11K | $815 | $11K | 5.34% |
| 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 | 10.00% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT SERVI | 136 E. S. TEMPLE #2300 SALT LAKE CITY, UT 84111 | AMERITAS LIFE INSURANCE CORP | $3K | $360 | $3K | 10.70% |
| 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 | $1K | $0 | $1K | 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 | $468 | $0 | $468 | 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 | $300 | $0 | $300 | 5.00% |
| DENISE ABBOTT4 | 2010 W 3211 S LOHAN, UT 84321 | PRE-PAID LEGAL SERVICES INC DBA LEGAL SHIELD | $2K | $0 | $2K | 34.73% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT | 136 EAST SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | CIGNA DENTAL HEALTH OF MARYLAND, INC | $35 | $0 | $35 | 4.99% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT | 136 EAST SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | CIGNA DENTAL HEALTH OF NEW MEXICO, INC | $16 | $0 | $16 | 5.13% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUMRX,INC EIN 33-0441200 PHARMACY BENEFIT MANGMNT | Claims processing; Other fees; Float revenue; Direct payment from the plan Service code 12 | — | $653K |
| UMR, INC EIN 39-1995276 CLAIMS PROCESSOR | Claims processing Service code 12 | — | $135K |
| DIVERSIFIED INSURANCE GROUP EIN 20-4442550 BROKER | Other commissions Service code 55 | — | $49K |
| CIGNA BEHAVIORAL HEALTH, INC EIN 41-1648670 ADMINISTRATOR | Direct payment from the plan; Contract Administrator; Participant communication; Claims processing Service code 12 | — | $0 |
| OPTUMRX | Other fees; Float revenue; Direct payment from the plan; Claims processing 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 | 762 | 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) | 762 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental(6 contracts, 6 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 403 | $252K |
| Vision | AMERITAS LIFE INSURANCE CORP | 499 | $30K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 762 | $76K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 420 | $377K |
| Other(2 contracts, 2 carriers) | HARTFORD LIFE AND ACCIDENT | 762 | $81K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 762 | — |
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."
No prospect flags tripped on this filing.