| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIETZ & CABALLERO INC3 Filed as: DIETZ AND CABALLERO INC | 5441 SOUTH MACADAM AVENUE SUITE 301 PORTLAND, OR 97239 | MODA HEALTH | $14K | $0 | $14K | 1.15% |
| MJ INSURANCE3 Filed as: MJI, INC | PO BOX 847 MCMINNVILLE, OR 97128 | MODA HEALTH | $4K | $0 | $4K | 0.29% |
| DIETZ & CABALLERO INC3 Filed as: DIETZ AND CABALLERO INC | 5441 SOUTH MACADAM AVENUE SUITE 301 PORTLAND, OR 97239 | OREGON DENTAL SERVICE DBA DELTAL DENTAL PLAN OF OREGON | $1K | $0 | $1K | 1.15% |
| MJ INSURANCE3 Filed as: MJI, INC | PO BOX 847 MCMINNVILLE, OR 97128 | OREGON DENTAL SERVICE DBA DELTAL DENTAL PLAN OF OREGON | $307 | $0 | $307 | 0.29% |
| DIETZ & CABALLERO INC3 Filed as: DIETZ AND CABALLERO INC | 5441 SOUTH MACADAM AVENUE SUITE 301 PORTLAND, OR 97239 | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | $321 | $0 | $321 | 1.15% |
| MJ INSURANCE3 Filed as: MJI, INC | PO BOX 847 MCMINNVILLE, OR 97128 | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | $81 | $0 | $81 | 0.29% |
| DIETZ & CABALLERO INC3 Filed as: DIETZ AND CABALLERO INC | 5441 SOUTH MACADAM AVENUE SUITE 301 PORTLAND, OR 97239 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 8.59% |
| MJ INSURANCE3 Filed as: MJI, INC | PO BOX 847 MCMINNVILLE, OR 97128 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $0 | $1K | 4.60% |
| DIETZ & CABALLERO INC3 Filed as: DIETZ AND CABALLERO INC | 5441 SOUTH MACADAM AVENUE SUITE 301 PORTLAND, OR 97239 | VISION SERVICE PLAN | $798 | $0 | $798 | 4.06% |
| MJ INSURANCE3 Filed as: MJI, INC | PO BOX 847 MCMINNVILLE, OR 97128 | VISION SERVICE PLAN | $177 | $0 | $177 | 0.90% |
| DIETZ & CABALLERO INC3 Filed as: DIETZ AND CABALLERO INC | 5441 SOUTH MACADAM AVENUE SUITE 301 PORTLAND, OR 97239 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 11.85% |
| MJ INSURANCE3 Filed as: MJI, INC | PO BOX 847 MCMINNVILLE, OR 97128 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $2K | $0 | $2K | 8.15% |
| DIETZ & CABALLERO INC3 Filed as: DIETZ AND CABALLERO INC | 5441 SOUTH MACADAM AVENUE SUITE 301 PORTLAND, OR 97239 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $792 | $0 | $792 | 5.83% |
| MJ INSURANCE3 Filed as: MJI, INC | PO BOX 847 MCMINNVILLE, OR 97128 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $568 | $0 | $568 | 4.18% |
| DIETZ & CABALLERO INC3 Filed as: DIETZ AND CABALLERO INC | 5441 SOUTH MACADAM AVENUE SUITE 301 PORTLAND, OR 97239 | MUTUAL OF OMAHA INSURANCE COMPANY | $133 | $0 | $133 | 5.65% |
| MJ INSURANCE3 Filed as: MJI, INC | PO BOX 847 MCMINNVILLE, OR 97128 | MUTUAL OF OMAHA INSURANCE COMPANY | $102 | $0 | $102 | 4.33% |
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 | 159 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 4 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 165 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | MODA HEALTH | 203 | $1.2M |
| Dental(2 contracts, 2 carriers) | OREGON DENTAL SERVICE DBA DELTAL DENTAL PLAN OF OREGON | 200 | $133K |
| Vision | VISION SERVICE PLAN | 152 | $20K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 159 | $33K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 159 | $24K |
| Prescription drug | MODA HEALTH | 203 | $1.2M |
| Other(2 contracts, 2 carriers) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 159 | $16K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 203 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.