| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SCOTT A. HAFETZ3 Filed as: SCOTT HAFETZ | 609 NEW ROAD LINWOOD, NJ 08221 | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | $29K | — | $29K | 2.48% |
| JANICE R HUSEBO3 Filed as: JANICE HUSEBO | PO BOX 19196 ASHEVILLE, NC 28815 | AFLAC | $4K | $261 | $5K | 7.12% |
| DANNY LEE3 | 4916 LEE DRIVE GARNER, NC 27529 | AFLAC | $2K | $214 | $2K | 3.30% |
| JACOB M KIMSEY3 Filed as: JACOB KIMSEY & OTHER AGENTS | 101 FOX COVE ROAD HENDERSONVILLE, NC 28792 | AFLAC | $2K | $91 | $2K | 2.70% |
| NATASHA ANN MCCORMICK3 Filed as: NATASHA MCCORMICK | 27 AMYS WAY BLACK MOUNTAIN, NC 28711 | AFLAC | $685 | $36 | $721 | 1.13% |
| TINA DAVIDSON3 | 503 TOMAHAWK DRIVE CLAYTON, NC 27520 | AFLAC | $461 | $38 | $499 | 0.78% |
| SUSAN RUSSELL3 | 504 SIMMONS VIEW DRIVE SEYMOUR, TN 37865 | AFLAC | $390 | $0 | $390 | 0.61% |
| LISA H MCKINNEY3 Filed as: LISA MCKINNEY | 56 GLEN COVE DRIVE ARDEN, NC 28704 | AFLAC | $388 | $0 | $388 | 0.61% |
| HAFETZ AND ASSOCIATES, LLC3 Filed as: HAFETZ & ASSOCIATES | 609 NEW ROAD LINWOOD, NJ 08221 | VISION SERVICE PLAN | $1K | — | $1K | 5.24% |
| UNKNOWN3 | UNKNOWN LENOIR, NC 28645 | NEW BENEFITS LTD | $1K | — | $1K | 19.49% |
| HAFETZ AND ASSOCIATES, LLC3 Filed as: HAFETZ & ASSOCIATES, LLC | 124 TURNER STREET MANTUA, NJ 08051 | USABLE LIFE | $271 | — | $271 | 9.90% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $136 | — | $136 | 4.97% |
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 | 108 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 108 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 211 | $1.2M |
| Dental | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 211 | $1.2M |
| Vision | VISION SERVICE PLAN | 147 | $23K |
| Life insurance(2 contracts, 2 carriers) | AFLAC | 73 | $67K |
| Short-term disability | AFLAC | 64 | $64K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 211 | $1.2M |
| Other(3 contracts, 3 carriers) | AFLAC | 73 | $73K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 211 | — |
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.