| 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 | $30K | $0 | $30K | 2.92% |
| JANICE R HUSEBO3 Filed as: JANICE R. HUSEBO | PO BOX 19196 ASHEVILLE, NC 28815 | AFLAC | $6K | $0 | $6K | 9.46% |
| DANNY LEE3 | 4916 LEE DRIVE GARNER, NC 27529 | AFLAC | $3K | $0 | $3K | 5.22% |
| MJ INSURANCE3 Filed as: RYAN SHADEL AND VARIOUS AGENTS | 3100 BLUFF LANE HILLSBOROUGH, NC 27278 | AFLAC | $2K | $0 | $2K | 3.18% |
| JANNEY HUSEBO3 | PO BOX 19196 ASHVILLE, NC 28815 | AFLAC | $1K | $0 | $1K | 2.14% |
| NATASHA ANN MCCORMICK3 Filed as: NATASHA ANN MCCCORMICK | 27 AMYS WAY BLACK MOUNTAIN, NC 28711 | AFLAC | $1K | $0 | $1K | 1.84% |
| JACOB M KIMSEY3 Filed as: JACOB KIMSEY | 101 FOX COVE ROAD HENDERSONVILLE, NC 28792 | AFLAC | $948 | $0 | $948 | 1.58% |
| TINA DAVIDSON3 | 503 TOMAHAWK DRIVE CLAYTON, NC 27520 | AFLAC | $716 | $0 | $716 | 1.19% |
| HAFETZ AND ASSOCIATES, LLC3 | 609 NEW ROAD LINWOOD, NJ 08221 | VISION SERVICE PLAN | $1K | $0 | $1K | 5.22% |
| HAFETZ AND ASSOCIATES, LLC3 | 124 TURNER STREET MANTUA, NJ 08051 | USABLE LIFE | $244 | $0 | $244 | 9.79% |
| MOSAIC GROUP SERVICES3 | PO BOX 2291 DURHAM, NC 27702 | USABLE LIFE | $122 | $0 | $122 | 4.89% |
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 | 99 | 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) | 99 | 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 | 108 | $1.0M |
| Dental | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 108 | $1.0M |
| Vision | VISION SERVICE PLAN | 146 | $23K |
| Life insurance(2 contracts, 2 carriers) | AFLAC | 71 | $62K |
| Short-term disability | AFLAC | 62 | $60K |
| Prescription drug(2 contracts, 2 carriers) | BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA | 108 | $1.0M |
| Other(3 contracts, 3 carriers) | AFLAC | 99 | $69K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 146 | — |
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.