| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INSURANCE BENEFITS | 136 E. SOUTH TEMPLE SUITE 2300 SALT LAKE CITY, UT 84111 | BLUE CROSS BLUE SHIELD OF UTAH | $98K | $22K | $120K | 5.81% |
| DIVERSIFIED INSURANCE GROUP3 Filed as: DIVERSIFIED INS. BENEFIT SERVICES | 136 E. SOUTH TEMPLE SUITE 2300 SALT LAKE CITY, UT 84111 | AMERITAS LIFE | $4K | $3K | $7K | 3.46% |
| DIVERSIFIED INSURANCE3 | 136 E. SOUTH TEMPLESUITE 2300 SALT LAKE CITY, UT 84111 | UNITED OF OMAHA LIFE INS. COMPANY | $6K | — | $6K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| REGENCE BLUE CROSS BLUE SHIELD EIN 87-0200138 CLAIMS PROCESSING PROVIDE | Float revenue; Direct payment from the plan; Claims processing Service code 12 | — | $180K |
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 | 271 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 271 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF UTAH | 271 | $2.1M |
| Dental | AMERITAS LIFE | 214 | $192K |
| Vision | AMERITAS LIFE | 214 | $192K |
| Life insurance | GERBER LIFE | 271 | $357K |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF UTAH | 271 | $2.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 492 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.