| 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 | $27K | $0 | $27K | 2.67% |
| MJ INSURANCE3 Filed as: JANICE ADAMS AND VARIOUS AGENTS | 92 RIDDLE ROAD SWANNANOA, NC 28778 | AFLAC | $3K | $65 | $4K | 5.77% |
| JANNEY HUSEBO3 | PO BOX 19009 ASHEVILLE, NC 28815 | AFLAC | $2K | $0 | $2K | 3.52% |
| DANNY LEE3 | 4916 LEE DRIVE GARNER, NC 27529 | AFLAC | $2K | $42 | $2K | 3.20% |
| JANICE R HUSEBO3 Filed as: JANICE HUSEBO | PO BOX 19009 ASHEVILLE, NC 28815 | AFLAC | $2K | $130 | $2K | 2.84% |
| TRACY L WARREN3 Filed as: TRACY WARREN | 2933B JESSICA DRIVE WINTERVILLE, NC 28590 | AFLAC | $1K | $55 | $1K | 2.14% |
| LISA H MCKINNEY3 Filed as: LISA MCKINNEY | 56 GLEN COVE DRIVE ARDEN, NC 28704 | AFLAC | $1K | $30 | $1K | 2.04% |
| SUSAN HAMER3 | 120 WEST ALLEN STREET, SUITE 20 HENDERSONVILLE, NC 28792 | AFLAC | $941 | $30 | $971 | 1.57% |
| MJ INSURANCE3 Filed as: JANICE B. ADAMS AND VARIOUS AGENTS | 92 RIDDLE ROAD SWANNANOA, NC 28778 | AFLAC | $1K | $0 | $1K | 5.31% |
| JANNEY HUSEBO3 Filed as: JANNEY A. HUSEBO | PO BOX 19009 ASHEVILLE, NC 28815 | AFLAC | $1K | $0 | $1K | 5.03% |
| DANNY LEE3 | 4916 LEE DRIVE GARNER, NC 27529 | AFLAC | $781 | $0 | $781 | 3.59% |
| LISA H MCKINNEY3 Filed as: LISA H. MCKINNEY | 56 GLEN COVE DRIVE ARDEN, NC 28704 | AFLAC | $457 | $0 | $457 | 2.10% |
| TRACY L WARREN3 Filed as: TRACY L. WARREN | 2933B JESSICA DRIVE WINTERVILLE, NC 28590 | AFLAC | $444 | $0 | $444 | 2.04% |
| SUSAN HAMER3 | 120 WEST ALLEN STREET, SUITE 20 HENDERSONVILLE, NC 28792 | AFLAC | $340 | $0 | $340 | 1.56% |
| JANICE R HUSEBO3 Filed as: JANICE R. HUSEBO | PO BOX 19009 ASHEVILLE, NC 28815 | AFLAC | $306 | $0 | $306 | 1.41% |
| HAFETZ AND ASSOCIATES, LLC3 Filed as: HAFETZ AND ASSOCIATES | 609 NEW ROAD LINWOOD, NJ 08221 | VISION SERVICE PLAN | $1K | $0 | $1K | 7.00% |
| HAFETZ AND ASSOCIATES, LLC3 Filed as: HAFETZ AND ASSOCIATES | 609 NEW ROAD LINWOOD, NJ 08221 | USABLE LIFE | $236 | $0 | $236 | 10.01% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $118 | $0 | $118 | 5.01% |
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 | 123 | 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) | 123 | 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 | 308 | $1.0M |
| Dental(3 contracts, 2 carriers) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 308 | $1.1M |
| Vision | VISION SERVICE PLAN | 135 | $20K |
| Life insurance(3 contracts, 2 carriers) | AFLAC | 88 | $86K |
| Short-term disability(2 contracts) | AFLAC | 88 | $83K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 308 | $1.0M |
| Other(3 contracts, 2 carriers) | AFLAC | 88 | $86K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 308 | — |
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.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.