| 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 | $120K | $11K | $132K | 5.90% |
| FIRST INSURANCE GROUP LLC3 | PO BOX 45279 OMAHA, NE 68145 | SUN LIFE ASSURANCE COMPANY OF CANADA | — | $45K | $45K | 2.32% |
| FIRST INSURANCE GROUP LLC3 | PO BOX 45279 OMAHA, NE 681450279 | AMERITAS LIFE INSURANCE CORP | $72K | $8K | $80K | 11.09% |
| FIRST INSURANCE GROUP LLC3 | DBA FNIC 14010 FNB PARKWAY SUITE 300 OMAHA, NE 68154 | AETNA LIFE INSURANCE CO. | $101K | — | $101K | 16.71% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| AETNA LIFE INSURANCE COMPANY CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 151 FARMINGTON AVE. HARTFORD, CT 06156 | $2.5M |
| METROPOLITAN LIFE INSURANCE COMPANY EIN 13-5581829 3RD PARTY SERVICE PROVIDE | Contract Administrator; Claims processing Service code 12 | — | $246K |
| LIVONGO HEALTH, INC 3RD PARTY SERVICE PROVIDE | Contract Administrator Service code 13 | 150 WEST EVELYN AVENUE MOUNTAIN VIEW, CA 94041 | $201K |
| OPTUM FINANCIAL SERVICES 3RD PARTY SERVICE PROVIDE | Contract Administrator; Claims processing Service code 12 | 11000 OPTUM CIRCLE EDEN PRAIRIE, MN 55344 | $131K |
| PAYFLEX SYSTEMS USA, INC. CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | 11819 MIAMI STREET SUITE 200 OMAHA, NE 68164 | $106K |
| AETNA BEHAVIORAL HEALTH PLAN ADMINISTRATOR | Contract Administrator Service code 13 | 151 FARMINGTON AVENUE RSAA HARTFORD, CT 06156 | $104K |
| JELLYVISION LAB, INC. 3RD PARTY SERVICES | Contract Administrator Service code 13 | 848 W EASTMAN ST. SUITE 104 CHICAGO, IL 60642 | $95K |
| AETNA EMPLOYEE ASSISTANCE PROGRAM EAP ADMINISTRATOR | Contract Administrator Service code 13 | 151 FARMINGTON AVE HARTFORD, CT 06156 | $85K |
| RXBENEFITS, INC. 3RD PARTY SERVICE | Contract Administrator Service code 13 | 3700 COLONNADE PKWY, STE 600 BIRMINGHAM, AL 35243 | $76K |
| 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 | $50K |
| LUTZ & COMPANY, PC EIN 47-0625816 AUDITOR | Accounting (including auditing) Service code 10 | — | $43K |
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 | 4,764 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 152 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 4,916 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | AMERITAS LIFE INSURANCE CORP | 6,564 | $721K |
| Life insurance | HARTFORD LIFE AND ACCIDENT | 4,764 | $2.2M |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 4,764 | $2.2M |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 4,572 | $1.9M |
| Other | HARTFORD LIFE AND ACCIDENT | 4,764 | $2.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 6,564 | — |
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 compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.