| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIETZ & CABALLERO INC3 Filed as: DIETZ & CABALLERO, INC | 5441 SW MACADAM AVENUE, SUITE 301 PORTLAND, OR 97239 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $22K | — | $22K | 2.95% |
| DIETZ & CABALLERO INC3 Filed as: DIETZ & CABALLERO, INC. | 5441 SW MACADAM AVENUE, SUITE 301 PORTLAND, OR 97239 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | — | $2K | $2K | 0.20% |
| DIETZ & CABALLERO INC3 Filed as: DIETZ & CABALLERO, INC. | 5441 SW MACADAM AVENUE, SUITE 301 PORTLAND, OR 97239 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | — | $8 | $8 | 0.00% |
| CANDY DIETZ3 | 5441 SW MADADAM AVENUE, SUITE 301 PORTLAND, OR 97239 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON | $6K | — | $6K | 4.20% |
| DIETZ & CABALLERO INC3 Filed as: DIETZ & CABALLERO, INC | 5441 SW MACADAM AVENUE, SUITE 301 PORTLAND, OR 97239 | METROPOLITAN LIFE INSURANCE COMPANY | $3K | — | $3K | 4.13% |
| DIETZ & CABALLERO INC3 Filed as: DIETZ & CABALLERO, INC | 5441 SW MACADAM AVENUE, SUITE 301 PORTLAND, OR 97239 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $1K | — | $1K | 9.12% |
| BENEFITS INC3 Filed as: THE BENEFITS GROUP, LLC | 601 EAST 22ND STREET VANCOUVER, WA 98663 | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | $295 | — | $295 | 2.56% |
| DIETZ & CABALLERO INC3 Filed as: DIETZ & CABALLERO, INC | 5441 SW MACADAM AVENUE, SUITE 301 PORTLAND, OR 97239 | VISION SERVICES PLAN | $645 | — | $645 | 8.17% |
| DIETZ & CABALLERO INC3 Filed as: DIETZ & CABALLERO, INC. | 5441 SW MACADAM AVENUE, SUITE 301 PORTLAND, OR 97239 | CASCADE CENTERS, INC. | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PACIFIC SOURCE ADMINISTRATORS EIN 30-0140934 NONE | Contract Administrator Service code 13 | — | $2K |
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 | 166 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 166 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | 123 | $745K |
| Dental | METROPOLITAN LIFE INSURANCE COMPANY | 242 | $80K |
| Vision | VISION SERVICES PLAN | 110 | $8K |
| Long-term disability | GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | 43 | $12K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 242 | — |
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."
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.