| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT | 136 E SOUTH TEMPLE SALT LAKE CITY, UT 84111 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $10K | $0 | $10K | 2.91% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT | 136 E SOUTH TEMPLE SALT LAKE CITY, UT 84111 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $0 | $5K | $5K | 1.47% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFIT S. | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | AMERITAS | $4K | $2K | $7K | 2.73% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS BENEFIT SERV | 136 EAST SOUTH TEMPLE SUITE 2300 SALT LAKE CITY, UT 84111 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $2K | $0 | $2K | 10.00% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS GROUP | 136 E S TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | REGENCE BLUECROSS BLUESHIELD OF UTAH | $0 | $0 | $0 | — |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS GROUP | 136 E SOUTH TEMPLE STE 2300 SALT LAKE CITY, UT 84111 | SELECTHEALTH | $0 | $0 | $0 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| REGENCE BLUECROSS BLUESHEILD OF UT EIN 87-0200138 CLAIMS PROCESSING | Float revenue; Claims processing; Direct payment from the plan Service code 12 | — | $681K |
| SELECTHEALTH EIN 87-0409820 CONTRACT ADMINISTRATOR | Claims processing Service code 12 | — | $444K |
| METROPOLITAN LIFE INSURANCE CO. EIN 13-5581829 CARRIER | Contract Administrator; Claims processing Service code 12 | — | $82K |
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 | 3,081 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 3,081 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | REGENCE BLUECROSS BLUESHIELD OF UTAH | 2,528 | $0 |
| Vision | AMERITAS | 2,864 | $241K |
| Life insurance(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 3,767 | $657K |
| Short-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 3,767 | $328K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 3,767 | $328K |
| Stop-loss / reinsurancereinsurance | SELECTHEALTH | 1,844 | $0 |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 3,767 | $657K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,767 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.