| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SCOTT A. HAFETZ3 | 609 NEW ROAD LINWOOD, NJ 08221 | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | $18K | $1K | $19K | 2.44% |
| DANNY LEE3 Filed as: DANNY LEE AND VARIOUS OTHER AGENTS | 4916 LEE DRIVE GARNER, NC 27529 | AFLAC | $3K | $327 | $4K | 7.31% |
| JANICE R HUSEBO3 Filed as: JANICE R. HUSEBO | PO BOX 19009 ASHEVILLE, NC 28815 | AFLAC | $3K | $379 | $3K | 6.63% |
| TRACY L WARREN3 | 2933B JESSICA DRIVE WINTERVILLE, NC 28590 | AFLAC | $852 | $44 | $896 | 1.72% |
| LISA H MCKINNEY3 | 56 GLEN COVE DRIVE ARDEN, NC 28704 | AFLAC | $797 | $86 | $883 | 1.70% |
| SUSAN RUSSELL3 | 120 WEST ALLEN STREET, SUITE 20 HENDERSONVILLE, NC 28795 | AFLAC | $789 | $86 | $875 | 1.68% |
| DAYLE R ANDERSON3 | 125 RACE TRACK ROAD LA GRANGE, NC 28551 | AFLAC | $765 | $102 | $867 | 1.67% |
| JANICE P ADAMS3 | 209 WOODLAND COURT BLACK MOUNTAIN, NC 28711 | AFLAC | $597 | $53 | $650 | 1.25% |
| HAFETZ AND ASSOCIATES, LLC3 | 609 NEW ROAD, SUITE D LINWOOD, NJ 08221 | VISION SERVICE PLAN | $1K | — | $1K | 7.00% |
| HAFETZ AND ASSOCIATES, LLC3 | 609 NEW ROAD LINWOOD, NJ 08221 | USABLE LIFE | $208 | — | $208 | 10.42% |
| MOSAIC GROUP SERVICES3 Filed as: MOSAIC GROUP | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $119 | — | $119 | 5.96% |
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. |
| 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) | 125 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 907 | $838K |
| Dental(2 contracts, 2 carriers) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 157 | $833K |
| Vision | VISION SERVICE PLAN | 108 | $16K |
| Life insurance(2 contracts, 2 carriers) | AFLAC | 82 | $54K |
| Short-term disability | AFLAC | 82 | $52K |
| Prescription drug | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 157 | $781K |
| Other(2 contracts, 2 carriers) | AFLAC | 82 | $54K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 907 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.