| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WHA INSURANCE AGENCY INC3 | 2930 CHAD DR STE 100 EUGENE, OR 97408 | MODA HEALTH PLAN, INC | $16K | — | $16K | 1.93% |
| KELLY BEHR HOWLAND3 | 2828 DEBBIE DR KLAMATH FALLS, OR 97601 | AFLAC | $1K | $91 | $1K | 3.23% |
| FRED W KOEHLER JR3 | 1003 BISMARK KLAMATH FALLS, OR 97601 | AFLAC | $742 | — | $742 | 1.98% |
| NOLA EVANS INC3 | 1111 N PONDEROSA ST CANBY, OR 97013 | AFLAC | $364 | — | $364 | 0.97% |
| LORI ANN PORTER3 | 2718 DEBBIE DRIVE KLAMATH FALLS, OR 97601 | AFLAC | $289 | $44 | $333 | 0.89% |
| KEEFE BURCHER3 Filed as: KEEFE P BURCHER | 201 W MAIN ST STE 4A MEDFORD, OR 97501 | AFLAC | $238 | $26 | $264 | 0.70% |
| DIXIE D SIMON3 Filed as: DIXIE SIMON | 509 N SHAMROCK RD SPOKANE VALLEY, WA 99037 | AFLAC | $219 | — | $219 | 0.58% |
| ROGER L OLSON3 Filed as: ROGER OLSON | 471 DAVIS LAKE ROAD USK, WA 99180 | AFLAC | $204 | — | $204 | 0.54% |
| KEEFE BURCHER3 | 33 N CENTRAL AVE STE 203 MEDFORD, OR 97501 | AFLAC | $177 | $18 | $195 | 0.52% |
| SCOTT NIELSEN3 | 1089 LAKE WASHINGTON BLVD N APT 306 RENTON, WA 98056 | AFLAC | $157 | — | $157 | 0.42% |
| ANDRE LAFLAMME3 | 9007 46TH COURT NW GIG HARBOR, WA 98335 | AFLAC | $100 | — | $100 | 0.27% |
| HAL HARRISON3 | 870 W CALLE DE EMILIA GREEN VALLEY, AZ 85614 | AFLAC | $77 | — | $77 | 0.21% |
| DEREK RENDER3 | 1912 LANCASTER AVE KLAMATH FALLS, OR 97601 | AFLAC | $65 | $7 | $72 | 0.19% |
| RICHARD J ROSS3 Filed as: RICHARD ROSS | 2463 NE BUCKWHEAT CT BEND, OR 97701 | AFLAC | $70 | — | $70 | 0.19% |
| PAUL MICHAEL HANNANT3 | 7180 SW FIR LOOP STE 250 TIGARD, OR 97223 | AFLAC | $53 | $16 | $69 | 0.18% |
| RAYMON P KEECH III3 | 8207 CAMPAIGN CIR RICHMOND, TX 77406 | AFLAC | $45 | $10 | $55 | 0.15% |
| FORREST LEAL3 | PO BOX 185 LIMA, MT 59739 | AFLAC | $49 | — | $49 | 0.13% |
| ERNEST E SNOOK3 Filed as: ERNEST SNOOK | 14011 282ND LN NE DUVALL, WA 98019 | AFLAC | $39 | — | $39 | 0.10% |
| RODERICK ALLEN BAIR3 | 505 N ARGONNE RD BUILDING C SPOKANE VALLEY, WA 99212 | AFLAC | $37 | — | $37 | 0.10% |
| PATRICIA GEE | PO BOX 2334 MESA, AZ 85214 | AFLAC | $35 | — | $35 | 0.09% |
| PATRICIA GEE3 | 70 SW CENTURY DR 100-153 BEND, OR 97702 | AFLAC | $27 | — | $27 | 0.07% |
| WHA INSURANCE AGENCY INC3 | 2930 CHAD DR EUGENE, OR 97408 | AFLAC | $20 | — | $20 | 0.05% |
| PHILLIP GOODRUM3 Filed as: PHILLIP ALLAN PAGE | 8870 SOUTH 500 EAST HUNTSVILLE, UT 84317 | AFLAC | $12 | $3 | $15 | 0.04% |
| BRADLEY E BAILEY3 Filed as: BRADLEY BAILEY | PO BOX 125 LIBERTY LAKE, WA 99019 | AFLAC | $8 | — | $8 | 0.02% |
| RICHARD J ROSS Filed as: RICHARD ROSS | 63146 WATERCRESS WAY BEND, OR 97701 | AFLAC | $8 | — | $8 | 0.02% |
| RODERICK ALLEN BAIR3 | 920 N ARGONNE RD STE 309 SPOKANE VALLEY, WA 99212 | AFLAC | $4 | — | $4 | 0.01% |
| WHA INSURANCE AGENCY INC3 Filed as: WHA INSURANCE AGENCY, INC. | 2930 CHAD DR STE 100 EUGENE, OR 974087382 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $948 | — | $948 | 10.00% |
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 | 135 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 0 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | MODA HEALTH PLAN, INC | 135 | $845K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 121 | $9K |
| Prescription drug(2 contracts, 2 carriers) | MODA HEALTH PLAN, INC | 135 | $845K |
| Stop-loss / reinsurancereinsurance | MODA HEALTH PLAN, INC | 135 | $807K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 135 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.