| 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 | $16K | $0 | $16K | 1.45% |
| JANNEY HUSEBO3 Filed as: JANNEY A. HUSEBO | PO BOX 19009 ASHEVILLE, NC 28815 | AFLAC | $2K | $0 | $2K | 4.57% |
| JANICE R HUSEBO3 Filed as: JANICE R. HUSEBO | PO BOX 19009 ASHEVILLE, NC 28815 | AFLAC | $1K | $0 | $1K | 2.94% |
| MJ INSURANCE3 Filed as: TRACY L. WARREN AND VARIOUS AGENTS | 2933B JESSICA DRIVE WINTERVILLE, NC 28590 | AFLAC | $899 | $0 | $899 | 2.34% |
| SUSAN RUSSELL3 | 120 ROCKWOOD DRIVE HENDERSONVILLE, NC 28792 | AFLAC | $437 | $0 | $437 | 1.14% |
| NATASHE ANN MCCORMICK3 | 27 AMYS WAY BLACK MOUNTAIN, NC 28711 | AFLAC | $351 | $0 | $351 | 0.91% |
| LISA H MCKINNEY3 Filed as: LISA H. MCKINNEY | 56 GLEN COVE DRIVE ARDEN, NC 28704 | AFLAC | $335 | $0 | $335 | 0.87% |
| DANNY LEE3 | 4916 LEE DRIVE GARNER, NC 27529 | AFLAC | $329 | $0 | $329 | 0.86% |
| HAFETZ AND ASSOCIATES, LLC3 Filed as: HAFETZ AND ASSOCIATES | 609 NEW ROAD, SUITE D 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 | NEW BENEFITS | $1K | $0 | $1K | 20.76% |
| HAFETZ AND ASSOCIATES, LLC3 Filed as: HAFETZ AND ASSOCIATES | 124 TURNER STREET MANTUA, NJ 08051 | USABLE LIFE | $231 | $0 | $231 | 10.02% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $115 | $0 | $115 | 4.99% |
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 | 130 | 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) | 130 | 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 | 192 | $1.1M |
| Dental | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 192 | $1.1M |
| Vision | VISION SERVICE PLAN | 130 | $20K |
| Life insurance(2 contracts, 2 carriers) | AFLAC | 65 | $41K |
| Short-term disability | AFLAC | 44 | $38K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 192 | $1.1M |
| Other(3 contracts, 3 carriers) | AFLAC | 65 | $46K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 192 | — |
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.