| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| DIETZ & CABALLERO INC Filed as: DIETZ & CABALLERO | 5441 SW MACADAM AVE., 301 PORTLAND, OR 97239 | KAISER FOUNDATION HEALTH PLAN NW | $22K | — | $22K | 3.50% |
| DIETZ & CABALLERO INC Filed as: DIETZ & CABALLERO | 5441 SE MACADAM AVE., 301 PORTLAND, OR 97239 | KAISER FOUNDATION HEALTH PLAN NW | $4K | — | $4K | 0.59% |
| DIETZ & CABALLERO INC3 Filed as: DIETZ & CABALLERO, INC | 5441 SW MACADAM AVE., SUITE 301 PORTLAND, OR 97239 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON | $3K | — | $3K | 3.50% |
| DIETZ & CABALLERO INC3 Filed as: DIETZ & CABALLERO | 5441 SW MACADAM AVENUE, STE 301 PORTLAND, OR 972393823 | METROPOLITAN LIFE INSURANCE COMPANY | $2K | — | $2K | 14.87% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PACIFICSOURCE ADMINISTRATORS INC EIN 30-0140934 NONE | Contract Administrator; Insurance services Service code 13 | — | $5K |
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 | 21 | 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) | 21 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN NW | 116 | $697K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 17 | $12K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 116 | — |
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.