| 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 | $18K | — | $18K | 2.09% |
| KELLY BEHR HOWLAND3 | 2828 DEBBIE DR KLAMATH FALLS, OR 97601 | AFLAC | $2K | $45 | $2K | 3.87% |
| FRED W KOEHLER JR3 | 1003 BISMARK KLAMATH FALLS, OR 97601 | AFLAC | $872 | — | $872 | 1.95% |
| LORI ANN PORTER3 | 2718 DEBBIE DRIVE KLAMATH FALLS, OR 97601 | AFLAC | $621 | $22 | $643 | 1.44% |
| KEEFE BURCHER3 | 201 W MAIN ST STE 4A MEDFORD, OR 97501 | AFLAC | $575 | $13 | $588 | 1.32% |
| NOLA EVANS INC3 | 1111 N PONDEROSA ST CANBY, OR 97013 | AFLAC | $337 | — | $337 | 0.75% |
| DEREK RENDER3 | 1912 LANCASTER AVE KLAMATH FALLS, OR 97601 | AFLAC | $270 | $13 | $283 | 0.63% |
| ROGER L OLSON3 Filed as: ROGER OLSON | 471 DAVIS LAKE ROAD USK, WA 99180 | AFLAC | $242 | — | $242 | 0.54% |
| DIXIE D SIMON3 Filed as: DIXIE SIMON | 509 N SHAMROCK RD SPOKANE VALLEY, WA 99037 | AFLAC | $241 | — | $241 | 0.54% |
| SCOTT NIELSEN3 | 1089 LAKE WASHINGTON BLVD N APT 306 RENTON, WA 98056 | AFLAC | $174 | — | $174 | 0.39% |
| HAL HARRISON3 | 870 W CALLE DE EMILIA GREEN VALLEY, AZ 85614 | AFLAC | $93 | — | $93 | 0.21% |
| ANDRE LAFLAMME3 | 9007 46TH COURT NW GIG HARBOR, WA 98335 | AFLAC | $87 | — | $87 | 0.19% |
| RICHARD J ROSS3 Filed as: RICHARD ROSS | 2463 NE BUCKWHEAT CT BEND, OR 97701 | AFLAC | $83 | — | $83 | 0.19% |
| FORREST LEAL3 | PO BOX 185 LIMA, MT 59739 | AFLAC | $57 | — | $57 | 0.13% |
| PATRICIA GEE3 | PO BOX 2334 MESA, OR 85214 | AFLAC | $52 | — | $52 | 0.12% |
| RODERICK ALLEN BAIR3 | 505 N ARGONNE RD BUILDING C SPOKANE VALLEY, WA 99212 | AFLAC | $50 | — | $50 | 0.11% |
| ERNEST E SNOOK3 Filed as: ERNEST SNOOK | 14011 282ND LN NE DUVALL, WA 98019 | AFLAC | $47 | — | $47 | 0.11% |
| RAYMON P KEECH III3 | 8207 CAMPAIGN CIR RICHMOND, TX 77406 | AFLAC | $33 | — | $33 | 0.07% |
| WHA INSURANCE AGENCY INC3 | 2930 CHAD DR EUGENE, OR 97408 | AFLAC | $19 | — | $19 | 0.04% |
| PHILLIP GOODRUM3 Filed as: PHILLIP ALLAN PAGE | 8870 SOUTH 500 EAST HUNTSVILLE, UT 84317 | AFLAC | $14 | — | $14 | 0.03% |
| PAUL MICHAEL HANNANT3 | 7180 SW FIR LOOP STE 250 TIGARD, OR 97223 | AFLAC | $13 | — | $13 | 0.03% |
| BRADLEY E BAILEY3 Filed as: BRADLEY BAILEY | PO BOX 125 LIBERTY LAKE, WA 99019 | AFLAC | $9 | — | $9 | 0.02% |
| SHANE EDMUND ATTEBERY3 | 1260 N DUTTON AVE STE 180 SANTA ROSA, CA 95401 | AFLAC | $5 | — | $5 | 0.01% |
| KIMBERLY A PARKS3 | 3702 30TH AVE SE OLYMPIA, WA 98501 | AFLAC | $3 | — | $3 | 0.01% |
| ERIC DANIEL WEILAND3 | 14511 SW CORNERSTONE LN SHERWOOD, OR 97140 | AFLAC | $2 | — | $2 | 0.00% |
| IOANNIS T GRATSINOPOULOS3 | 3565 SUMMERLINN DR WEST LINN, OR 97068 | AFLAC | $2 | — | $2 | 0.00% |
| GINA SIENIA3 | 8710 SW ASH MEADOWS RD APT 1137 WILSONVILLE, OR 97070 | AFLAC | $2 | — | $2 | 0.00% |
| MATTHEW G BERGER3 Filed as: MATTHEW SHROYER | 7407 N WILLIAMS AVE PORTLAND, OR 97217 | AFLAC | $1 | — | $1 | 0.00% |
| WHA INSURANCE AGENCY INC3 Filed as: WHA INSURANCE AGENCY, INC. | 2930 CHAD DR STE 100 EUGENE, OR 974087382 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $935 | — | $935 | 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) | 135 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | MODA HEALTH PLAN, INC | 135 | $886K |
| Dental | MODA HEALTH PLAN, INC | 135 | $842K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 118 | $9K |
| Prescription drug(2 contracts, 2 carriers) | MODA HEALTH PLAN, INC | 135 | $886K |
| Stop-loss / reinsurancereinsurance | MODA HEALTH PLAN, INC | 135 | $842K |
| 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.