| 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 | $17K | — | $17K | 1.84% |
| WHA INSURANCE AGENCY INC3 | 2930 CHAD DR STE 100 EUGENE, OR 974087382 | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | $3K | — | $3K | 5.05% |
| KELLY BEHR HOWLAND3 | 2828 DEBBIE DR KLAMATH FALLS, OR 97601 | AFLAC | $3K | $99 | $3K | 5.61% |
| FRED W KOEHLER JR3 | 1003 BISMARK KLAMATH FALLS, OR 97601 | AFLAC | $850 | — | $850 | 1.70% |
| KEEFE BURCHER3 Filed as: KEEFE B BURCHER | 201 W MAIN ST STE 4A MEDFORD, OR 97501 | AFLAC | $767 | $25 | $792 | 1.58% |
| LORI ANN PORTER3 | 2718 DEBBIE DRIVE KLAMATH FALLS, OR 97601 | AFLAC | $661 | $25 | $686 | 1.37% |
| DEREK RENDER3 | 1318 JOHNSON AVE KLAMATH FALLS, OR 97601 | AFLAC | $526 | $25 | $551 | 1.10% |
| NOLA EVANS INC3 | 1111 N PONDEROSA ST CANBY, OR 97013 | AFLAC | $309 | — | $309 | 0.62% |
| ROGER L OLSON3 | 471 DAVIS LAKE ROAD USK, WA 99180 | AFLAC | $236 | — | $236 | 0.47% |
| DIXIE D SIMON3 | 509 N SHAMROCK RD SPOKANE VALLEY, WA 99037 | AFLAC | $227 | — | $227 | 0.45% |
| SCOTT NIELSEN3 | 1089 LAKE WASHINGTON BLVD N APT 306 RENTON, WA 98056 | AFLAC | $168 | — | $168 | 0.34% |
| HAL HARRISON3 | 870 W CALLE DE EMILIA GREEN VALLEY, AZ 85614 | AFLAC | $93 | — | $93 | 0.19% |
| RICHARD J ROSS3 | 2463 NE BUCKWHEAT CT BEND, OR 97701 | AFLAC | $78 | — | $78 | 0.16% |
| ANDRE LAFLAMME3 | 9007 46TH COURT NW GIG HARBOR, WA 98335 | AFLAC | $74 | — | $74 | 0.15% |
| FORREST LEAL3 | PO BOX 185 LIMA, MT 59739 | AFLAC | $57 | — | $57 | 0.11% |
| RODERICK ALLEN BAIR3 | 505 N ARGONNE RD BUILDING C SPOKANE VALLEY, WA 99212 | AFLAC | $50 | — | $50 | 0.10% |
| ERNEST E SNOOK3 Filed as: ERNEST SNOOK | 14011 282ND LN NE DUVALL, WA 98019 | AFLAC | $47 | — | $47 | 0.09% |
| PATRICIA J GEE3 | PO BOX 2334 MESA, AZ 85214 | AFLAC | $45 | — | $45 | 0.09% |
| RAYMON P KEECH III3 | 8207 CAMPAIGN CIR RICHMOND, TX 77406 | AFLAC | $28 | — | $28 | 0.06% |
| WHA INSURANCE AGENCY INC3 | 2930 CHAD DR EUGENE, OR 97408 | AFLAC | $18 | — | $18 | 0.04% |
| SHANE EDMUND ATTEBERY3 | 1260 N DUTTON AVE STE 180 SANTA ROSA, CA 95401 | AFLAC | $18 | — | $18 | 0.04% |
| PAUL MICHAEL HANNANT3 | 7180 SW FIR LOOP STE 250 TIGARD, OR 97223 | AFLAC | $12 | — | $12 | 0.02% |
| KIMBERLY A PARKS3 | 3702 30TH AVE SE OLYMPIA, WA 98501 | AFLAC | $11 | — | $11 | 0.02% |
| PHILLIP GOODRUM3 Filed as: PHILLIP ALLAN PAGE | 8870 SOUTH 500 EAST HUNTSVILLE, UT 84317 | AFLAC | $10 | — | $10 | 0.02% |
| BRADLEY E BAILEY3 | PO BOX 125 LIBERTY LAKE, WA 99019 | AFLAC | $9 | — | $9 | 0.02% |
| ERIC DANIEL WEILAND3 | 14511 SW CORNERSTONE LN SHERWOOD, OR 97140 | AFLAC | $9 | — | $9 | 0.02% |
| IOANNIS T GRATSINOPOULOS3 | 3565 SUMMERLINN DR WEST LINN, OR 97068 | AFLAC | $8 | — | $8 | 0.02% |
| GINA SIENIA3 | 8710 SW ASH MEADOWS RD APT 1137 WILSONVILLE, OR 97070 | AFLAC | $7 | — | $7 | 0.01% |
| MATTHEW G BERGER3 Filed as: MATTHEW SHROYER | 7407 N WILLIAMS AVE PORTLAND, OR 97217 | AFLAC | $3 | — | $3 | 0.01% |
| MICHAEL C WALKER3 Filed as: MICHAEL M STASTNY | 605 PORTLAND AVE UNIT 531 GLADSTONE, OR 97027 | AFLAC | $2 | — | $2 | 0.00% |
| MARCI MARIE OTIS3 | 200 JULINA LN ROSEBURG, OR 97471 | AFLAC | $2 | — | $2 | 0.00% |
| MJ INSURANCE3 Filed as: ROBIN D HUDSON | PO BOX 1124 ASTORIA, OR 97103 | AFLAC | $1 | — | $1 | 0.00% |
| HEATHER F CHRISTENSEN3 | PO BOX 784 MORONI, UT 84646 | AFLAC | $1 | — | $1 | 0.00% |
| MICHAEL C WALKER3 Filed as: MICHAEL A STACHOWIAK | 321 N CLARK ST STE 625 CHICAGO, IL 60654 | 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 | $942 | — | $942 | 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 | 138 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 138 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | MODA HEALTH PLAN, INC | 138 | $955K |
| Dental | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | 137 | $51K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 122 | $9K |
| Prescription drug(2 contracts, 2 carriers) | MODA HEALTH PLAN, INC | 138 | $955K |
| Stop-loss / reinsurancereinsurance | MODA HEALTH PLAN, INC | 138 | $905K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 138 | — |
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.