| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIETZ & CABALLERO INC3 Filed as: DIETZ & CABALLERO | 5441 SW MACADAM AVE., SUITE 301 PORTLAND, OR 97239 | MODA, INC. | $16K | — | $16K | 1.83% |
| DIETZ & CABALLERO INC3 Filed as: DIETZ & CABALLERO | 5441 SW MACADAM STE 301 PORTLAND, OR 97239 | MODA, INC. | $3K | — | $3K | 3.97% |
| DIETZ & CABALLERO INC3 | 5441 SW MACADAM AVE STE 301 PORTLAND, OR 97239 | VISION CARE FOR LIFE | $971 | — | $971 | 5.99% |
| DIETZ & CABALLERO INC3 | 5441 SW MACADAM AVE STE 301 PORTLAND, OR 97239 | UNITED OF OMAHA LIFE INSURANCE COMPANY - LT DISABILITY | $2K | — | $2K | 14.79% |
| DIETZ & CABALLERO INC3 | 5441 SW MACADAM AVE STE 301 PORTLAND, OR 97239 | UNITED OF OMAHA LIFE INSURANCE COMPANY - VOLUNTARY LIFE | $3K | — | $3K | 20.00% |
| DIETZ & CABALLERO INC3 | 5441 SW MACADAM AVE STE 301 PORTLAND, OR 97239 | UNITED OF OMAHA LIFE INSURANCE COMPANY - LIFE & AD&D | $1K | — | $1K | 10.00% |
| DIETZ & CABALLERO INC3 | 5441 SW MACADAM AVE STE 301 PORTLAND, OR 97239 | PACIFIC SOURCE ADMINISTRATORS INC - FSA/ COBRA ADMINISTRATION | — | $7K | $7K | — |
No Schedule C service providers reported on this filing.
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 | 121 | 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) | 121 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MODA, INC. | 109 | $856K |
| Dental | MODA, INC. | 121 | $76K |
| Vision | VISION CARE FOR LIFE | 118 | $16K |
| Life insurance(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY - VOLUNTARY LIFE | 119 | $26K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY - LT DISABILITY | 119 | $16K |
| Other | PACIFIC SOURCE ADMINISTRATORS INC - FSA/ COBRA ADMINISTRATION | 111 | $0 |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 121 | — |
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.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.