| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIETZ & CABALLERO INC3 Filed as: DIETZ & CABALLERO | 5441 SW MACADAM AVE STE 301 PORTLAND, OR 97239 | PROVIDENCE HEALTH PLANS | $31K | — | $31K | 3.50% |
| DIETZ & CABALLERO INC3 Filed as: DIETZ & CABALLERO | 5441 SW MACADAM STE 301 PORTLAND, OR 97239 | MODA, INC. - DENTAL | $4K | — | $4K | 3.43% |
| 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 - LT DISABILITY | $2K | — | $2K | 14.35% |
| DIETZ & CABALLERO INC3 | 5441 SW MACADAM AVE STE 301 PORTLAND, OR 97239 | VISION CARE FOR LIFE | $993 | — | $993 | 5.90% |
| DIETZ & CABALLERO INC3 | 5441 SW MACADAM AVE STE 301 PORTLAND, OR 97239 | UNITED OF OMAHA LIFE INSURANCE COMPANY - LIFE & AD&D | $1K | — | $1K | 9.52% |
| DIETZ & CABALLERO INC3 Filed as: DIETZ & CABALLERO INC. | 5441 SE MACADAM AVENUE, SUITE 301 PORTLAND, OR 97239 | UNITED OF OMAHA LIFE INSURANCE COMPANY - VOLUNTARY AD&D | $222 | — | $222 | 10.00% |
| DIETZ & CABALLERO INC3 Filed as: DIETZ & CABALLERO | 5441 SW MACADAM AVE., SUITE 301 PORTLAND, OR 97239 | PACIFICE SOURCE HEALTH PLANS - MEDICAL | — | — | $0 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PACIFIC SOURCE ADMINISTRATORS EIN 30-0140934 NONE | Contract Administrator Service code 13 | — | $7K |
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 | 214 | 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) | 214 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | PROVIDENCE HEALTH PLANS | 157 | $874K |
| Dental | MODA, INC. - DENTAL | 214 | $113K |
| Vision | VISION CARE FOR LIFE | 121 | $17K |
| Life insurance(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY - VOLUNTARY LIFE | 124 | $29K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY - LT DISABILITY | 124 | $17K |
| Other | UNITED OF OMAHA LIFE INSURANCE COMPANY - VOLUNTARY AD&D | 35 | $2K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 214 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.