| 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 | 1.70% |
| KELLY BEHR HOWLAND3 | 2828 DEBBIE DR KLAMATH FALLS, OR 97601 | AFLAC | $2K | $93 | $2K | 4.49% |
| FRED W KOEHLER JR3 | 1003 BISMARK KLAMATH FALLS, OR 97601 | AFLAC | $757 | — | $757 | 1.47% |
| DEREK RENDER3 | 1318 JOHNSON AVE KLAMATH FALLS, OR 97601 | AFLAC | $690 | $24 | $714 | 1.39% |
| KEEFE BURCHER3 Filed as: KEEFE B BURCHER | 3221 ROGUE RIVER HWY STE 4A GOLD HILL, OR 97525 | AFLAC | $652 | $24 | $676 | 1.32% |
| LORI ANN PORTER3 | 2718 DEBBIE DRIVE KLAMATH FALLS, OR 97601 | AFLAC | $522 | $29 | $551 | 1.07% |
| NOLA EVANS INC3 | 10853 S RIDGE TOP DR MOLALLA, OR 97038 | AFLAC | $250 | — | $250 | 0.49% |
| DIXIE D SIMON3 | 509 N SHAMROCK RD SPOKANE VALLEY, WA 99037 | AFLAC | $215 | — | $215 | 0.42% |
| ROGER L OLSON3 | 471 DAVIS LAKE ROAD USK, WA 99180 | AFLAC | $204 | — | $204 | 0.40% |
| SCOTT NIELSEN3 | 718B FOURTH PLAIN BLVD VANCOUVER, WA 98660 | AFLAC | $144 | — | $144 | 0.28% |
| HAL HARRISON3 | 870 W CALLE DE EMILIA GREEN VALLEY, AZ 85614 | AFLAC | $82 | — | $82 | 0.16% |
| RICHARD J ROSS3 | 1337 NE BARNEY ST PRINEVILLE, OR 97754 | AFLAC | $62 | — | $62 | 0.12% |
| FORREST LEAL3 | PO BOX 185 LIMA, MT 59739 | AFLAC | $55 | — | $55 | 0.11% |
| RODERICK ALLEN BAIR3 | 8827 N GOVERNMENT WAY #105 HAYDEN, ID 83835 | AFLAC | $54 | — | $54 | 0.11% |
| ANDRE LAFLAMME3 | 9007 46TH COURT NW GIG HARBOR, WA 98335 | AFLAC | $53 | — | $53 | 0.10% |
| NOAH BAILEY | 201 W MAIN ST STE 4A MEDFORD, OR 97501 | AFLAC | $44 | — | $44 | 0.09% |
| ERNEST E SNOOK3 Filed as: ERNEST SNOOK | 14011 282ND LN NE DUVALL, WA 98019 | AFLAC | $42 | — | $42 | 0.08% |
| 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 | $22 | — | $22 | 0.04% |
| WHA INSURANCE AGENCY INC3 | 2930 CHAD DR EUGENE, OR 97408 | AFLAC | $17 | — | $17 | 0.03% |
| SHANE EDMUND ATTEBERY3 | 391 RANDY DR GRANTS PASS, OR 97527 | AFLAC | $13 | — | $13 | 0.03% |
| BRADLEY E BAILEY3 | PO BOX 125 LIBERTY LAKE, WA 99019 | AFLAC | $10 | — | $10 | 0.02% |
| KIMBERLY A PARKS3 | 19818 N 147TH DR SUN CITY WEST, AZ 85375 | AFLAC | $8 | — | $8 | 0.02% |
| PHILLIP GOODRUM3 Filed as: PHILLIP ALLAN PAGE | 8870 SOUTH 500 EAST HUNTSVILLE, UT 84317 | AFLAC | $7 | — | $7 | 0.01% |
| ERIC DANIEL WEILAND3 | 14511 SW CORNERSTONE LN SHERWOOD, OR 97140 | AFLAC | $7 | — | $7 | 0.01% |
| GINA SIENIA3 | PO BOX 446 ECHO, OR 97826 | AFLAC | $7 | — | $7 | 0.01% |
| IOANNIS T GRATSINOPOULOS3 | 1893 E DAULBY ST MERIDIAN, ID 83642 | AFLAC | $6 | — | $6 | 0.01% |
| PAUL MICHAEL HANNANT3 | 6052 SAWGRASS ST SE SALEM, OR 97306 | AFLAC | $3 | — | $3 | 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 | 22100 NE HALSEY ST APT 354 FAIRVIEW, OR 97024 | 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 | 7.04% |
| WHA INSURANCE AGENCY INC3 Filed as: WHA INSURANCE AGENCY, INC. | 2930 CHAD DR STE 100 EUGENE, OR 974087382 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 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 | 125 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 125 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | MODA HEALTH PLAN, INC | 125 | $979K |
| Dental | OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | 122 | $32K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 116 | $10K |
| Prescription drug(2 contracts, 2 carriers) | MODA HEALTH PLAN, INC | 125 | $979K |
| Stop-loss / reinsurancereinsurance | MODA HEALTH PLAN, INC | 124 | $928K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 125 | — |
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.