| 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 | $101K | — | $101K | 4.99% |
| FIRST INSURANCE GROUP LLC3 | PO BOX 45279 OMAHA, NE 681450279 | AMERITAS LIFE INSURANCE CORP | $58K | $7K | $65K | 11.27% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 151 FARMINGTON AVE. HARTFORD, CT 06156 | $2.2M |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 3RD PARTY SERVICE PROVIDE | Contract Administrator; Claims processing Service code 12 | — | $226K |
| DIA-TEC CLOUD 3RD PARTY SERVICE PROVIDE | Contract Administrator Service code 13 | 2910 S 84TH ST. OMAHA, NE 68124 | $152K |
| PAYFLEX SYSTEMS USA, INC. CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 11819 MIAMI STREET SUITE 200 OMAHA, NE 68164 | $90K |
| JELLYVISION LAB, INC. 3RD PARTY SERVICES | Contract Administrator Service code 13 | 848 W EASTMAN ST. SUITE 104 CHICAGO, IL 60642 | $77K |
| AETNA EMPLOYEE ASSISTANCE PROGRAM EAP ADMINISTRATOR | Contract Administrator Service code 13 | 151 FARMINGTON AVE HARTFORD, CT 06156 | $71K |
| OPTUM FINANCIAL SERVICES 3RD PARTY SERVICE PROVIDE | Claims processing; Contract Administrator Service code 12 | 11000 OPTUM CIRCLE EDEN PRAIRIE, MN 55344 | $63K |
| FIRST NATIONAL OF NEBRASKA, INC. TRUSTEE | Contract Administrator; Trustee (bank, trust company, or similar financial institution) Service code 13 | 1620 DODGE STREET STOP 3390 OMAHA, NE 68197 | $55K |
| LUTZ & COMPANY, PC EIN 47-0625816 AUDITOR | Accounting (including auditing) Service code 10 | — | $30K |
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 | 4,403 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 239 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 4,642 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | AMERITAS LIFE INSURANCE CORP | 6,021 | $578K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 4,403 | $2.0M |
| Short-term disability | HARTFORD LIFE AND ACCIDENT | 4,403 | $2.0M |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 4,403 | $2.0M |
| Stop-loss / reinsurancereinsurance | AETNA LIFE INSURANCE COMPANY | 3,664 | $1.5M |
| Other | HARTFORD LIFE AND ACCIDENT | 4,403 | $2.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 6,021 | — |
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.