| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FIRST INSURANCE GROUP LLC3 | 14010 FNB PKWY STE 300 OMAHA, NE 68154 | HARTFORD LIFE AND ACCIDENT | $7K | $2K | $8K | 5.49% |
| FIRST INSURANCE GROUP LLC3 | PO BOX 45279 OMAHA, NE 68145 | AMERITAS LIFE INSURANCE CORP | $7K | $1K | $8K | 11.59% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY CONTRACT ADMINISRATOR | Contract Administrator Service code 13 | 151 FARMINGTON AVE. HARTFORD, CT 06156 | $252K |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 3RD PARTY ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $26K |
| DIA-TEC CLOUD 3RD PARTY SERVICES | Contract Administrator Service code 13 | 2910 S 84TH ST. OMAHA, NE 68124 | $13K |
| JELLYVISION LAB 3RD PARTY SERVICES | Contract Administrator Service code 13 | 848 W EASTMAN ST. SUITE 104 CHICAGO, IL 60642 | $9K |
| OPTUM FINANCIAL SERVICES 3RD PARTY SERVICE PROVIDE | Claims processing; Contract Administrator Service code 12 | 11000 OPTUM CIRCLE EDEN PRAIRE, MN 55344 | $6K |
| AETNA EMPLOYEE ASSISTANCE PROGRAM EAP ADMINISTRATOR | Contract Administrator Service code 13 | 151 FARMINGTON AVE HARTFORD, CT 06156 | $6K |
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 | 383 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 20 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 403 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | AMERITAS LIFE INSURANCE CORP | 646 | $68K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 383 | $149K |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 383 | $149K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 383 | $149K |
| Stop-loss / reinsurancereinsurance | AETNA LIFE INSURANCE COMPANY | 384 | $138K |
| Other | HARTFORD LIFE AND ACCIDENT | 383 | $149K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 646 | — |
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.