| 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 | 1.84% |
| KELLY BEHR HOWLAND3 | 2828 DEBBIE DR KLAMATH FALLS, OR 97601 | AFLAC | $2K | $184 | $2K | 4.85% |
| FRED W KOEHLER JR3 | 1003 BISMARK KLAMATH FALLS, OR 97601 | AFLAC | $757 | — | $757 | 1.59% |
| KEEFE BURCHER3 Filed as: KEEFE B BURCHER | 201 W MAIN ST STE 4A MEDFORD, OR 97501 | AFLAC | $646 | $46 | $692 | 1.45% |
| DEREK RENDER3 | 1318 JOHNSON AVE KLAMATH FALLS, OR 97601 | AFLAC | $574 | $46 | $620 | 1.30% |
| LORI ANN PORTER3 | 2718 DEBBIE DRIVE KLAMATH FALLS, OR 97601 | AFLAC | $534 | $46 | $580 | 1.22% |
| NOLA EVANS INC3 | 10853 S RIDGE TOP DR MOLALLA, OR 97038 | AFLAC | $266 | — | $266 | 0.56% |
| ROGER L OLSON3 | 471 DAVIS LAKE ROAD USK, WA 99180 | AFLAC | $218 | — | $218 | 0.46% |
| DIXIE D SIMON3 | 509 N SHAMROCK RD SPOKANE VALLEY, WA 99037 | AFLAC | $213 | — | $213 | 0.45% |
| SCOTT NIELSEN3 | 1089 LAKE WASHINGTON BLVD N APT 306 RENTON, WA 98056 | AFLAC | $145 | — | $145 | 0.30% |
| HAL HARRISON3 | 870 W CALLE DE EMILIA GREEN VALLEY, AZ 85614 | AFLAC | $80 | — | $80 | 0.17% |
| RICHARD J ROSS3 | 2463 NE BUCKWHEAT CT BEND, OR 97701 | AFLAC | $65 | — | $65 | 0.14% |
| ANDRE LAFLAMME3 | 9007 46TH COURT NW GIG HARBOR, WA 98335 | AFLAC | $59 | — | $59 | 0.12% |
| FORREST LEAL3 | PO BOX 185 LIMA, MT 59739 | AFLAC | $51 | — | $51 | 0.11% |
| RODERICK ALLEN BAIR3 | 2900 N GOVERNMENT WAY 19 COEUR D ALENE, ID 83815 | AFLAC | $50 | — | $50 | 0.10% |
| ERNEST E SNOOK3 Filed as: ERNEST SNOOK | 14011 282ND LN NE DUVALL, WA 98019 | AFLAC | $43 | — | $43 | 0.09% |
| PATRICIA J GEE3 | PO BOX 2334 MESA, AZ 85214 | AFLAC | $40 | — | $40 | 0.08% |
| RAYMON P KEECH III3 | 8207 CAMPAIGN CIR RICHMOND, TX 77406 | AFLAC | $24 | — | $24 | 0.05% |
| WHA INSURANCE AGENCY INC3 | 2930 CHAD DR EUGENE, OR 97408 | AFLAC | $18 | — | $18 | 0.04% |
| SHANE EDMUND ATTEBERY3 | 391 RANDY DR GRANTS PASS, OR 97527 | AFLAC | $14 | — | $14 | 0.03% |
| KIMBERLY A PARKS3 | 19818 N 147TH DR SUN CITY WEST, AZ 85375 | AFLAC | $9 | — | $9 | 0.02% |
| BRADLEY E BAILEY3 | PO BOX 125 LIBERTY LAKE, WA 99019 | AFLAC | $9 | — | $9 | 0.02% |
| GINA SIENIA3 | PO BOX 446 ECHO, OR 97826 | AFLAC | $7 | — | $7 | 0.01% |
| ERIC DANIEL WEILAND3 | 14511 SW CORNERSTONE LN SHERWOOD, OR 97140 | AFLAC | $7 | — | $7 | 0.01% |
| PHILLIP GOODRUM3 Filed as: PHILLIP ALLAN PAGE | 8870 SOUTH 500 EAST HUNTSVILLE, UT 84317 | AFLAC | $6 | — | $6 | 0.01% |
| IOANNIS T GRATSINOPOULOS3 | 3565 SUMMERLINN DR WEST LINN, OR 97068 | AFLAC | $6 | — | $6 | 0.01% |
| PAUL MICHAEL HANNANT3 | 6052 SAWGRASS ST SE SALEM, OR 97306 | AFLAC | $5 | — | $5 | 0.01% |
| MATTHEW G BERGER3 Filed as: MATTHEW SHROYER | 1384 NE 70TH AVE PORTLAND, OR 97213 | AFLAC | $2 | — | $2 | 0.00% |
| MICHAEL C WALKER3 Filed as: MICHAEL M STASTNY | 605 PORTLAND AVE UNIT 531 GLADSTONE, OR 97027 | AFLAC | $1 | — | $1 | 0.00% |
| MARCI MARIE OTIS3 | 200 JULINA LN ROSEBURG, OR 97471 | AFLAC | $1 | — | $1 | 0.00% |
| MJ INSURANCE3 Filed as: ROBIN D HUDSON | 15000 DAVIS LN APT 80 LAKE OSWEGO, OR 97035 | AFLAC | $1 | — | $1 | 0.00% |
| WHA INSURANCE AGENCY INC3 | 2930 CHAD DR STE 100 EUGENE, OR 974087382 | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | $2K | — | $2K | 10.76% |
| WHA INSURANCE AGENCY INC3 Filed as: WHA INSURANCE AGENCY, INC. | 2930 CHAD DR STE 100 EUGENE, OR 974087382 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $932 | — | $932 | 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 | 133 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 133 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | MODA HEALTH PLAN, INC | 133 | $919K |
| Dental | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | 132 | $22K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 120 | $9K |
| Prescription drug(2 contracts, 2 carriers) | MODA HEALTH PLAN, INC | 133 | $919K |
| Stop-loss / reinsurancereinsurance | MODA HEALTH PLAN, INC | 133 | $871K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 133 | — |
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.