| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| FIRST INSURANCE GROUP LLC3 | PO BOX 45279 OMAHA, NE 681450279 | BLUE CROSS BLUE SHIELD OF NEBRASKA | $171K | — | $171K | 0.46% |
| INSGROUP INC3 Filed as: FIRST INS GROUP LLC | PO BOX 45279 OMAHA, NE 681450279 | HARTFORD LIFE AND ACCIDENT | $99K | — | $99K | 5.02% |
| FIRST INSURANCE GROUP LLC3 | PO BOX 45279 OMAHA, NE 681450279 | AMERITAS LIFE INSURANCE CORP | $45K | $6K | $52K | 11.40% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| VIVERAE, INC. EIN 26-4218002 3RD PARTY SVC PROVIDER | Contract Administrator Service code 13 | — | $576K |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 3RD PARTY SERVICE PROVIDE | Claims processing; Contract Administrator Service code 12 | — | $194K |
| COMPSYCH CORPORATION EIN 36-3739783 EAP ADMINISTRATOR | Contract Administrator Service code 13 | — | $76K |
| PAYFLEX EIN 91-1774434 3RD PARTY SERVICE PROVIDE | Claims processing; Contract Administrator Service code 12 | — | $54K |
| INFINISOURCE EIN 38-2976613 3RD PARTY SERVICE PROVIDE | Contract Administrator Service code 13 | — | $32K |
| LUTZ & COMPANY, P.C. EIN 47-0625816 AUDITOR | Accounting (including auditing) Service code 10 | — | $27K |
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 | 4,745 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 52 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 12 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 4,809 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF NEBRASKA | 7,735 | $37.6M |
| Vision | AMERITAS LIFE INSURANCE CORP | 5,607 | $454K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 4,709 | $2.0M |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 4,709 | $2.0M |
| Stop-loss / reinsurancereinsurance | BLUE CROSS BLUE SHIELD OF NEBRASKA | 7,735 | $37.6M |
| Other | HARTFORD LIFE AND ACCIDENT | 4,709 | $2.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 7,735 | — |
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."
Broker comp is under 1% of premium on a >$1M plan. Plan may be flying solo or paying a flat fee — consultant sales target.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.