| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CREATIVA ASSOCIATES FINANCIAL & INS3 Filed as: CREATIVA ASSOCIATES FINANCIAL AND I | 28470 AVENUE STANFORD SUITE 300 VALENCIA, CA 91355 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $34K | $8K | $42K | 3.87% |
| AXA ASSISTANCE, USA5 | 122 SOUTH MICHIGAN AVENUE SUITE 1100 CHICAGO, IL 606036115 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | — | $189 | $189 | 0.02% |
| CREATIVA ASSOCIATES FINANCIAL & INS3 | 28470 AVENUE STANFORD SUITE 300 VALENCIA, CA 91355 | KAISER FOUNDATION HEALTH PLAN INC | $40K | — | $40K | 6.49% |
| CREATIVA ASSOCIATES FINANCIAL & INS3 | 28470 AVENUE STANFORD SUITE 300 VALENCIA, CA 91355 | VISION SERVICE PLAN | $3K | — | $3K | 2.85% |
| LINDA L WIKLE3 | 7174 DEEPWATER POINT RD WILLIAMSBURG, MI 49690 | AFLAC | $75 | — | $75 | 1.00% |
| CHERYL A STIFF3 | PO BOX 793 GAYLORD, MI 49734 | AFLAC | $43 | — | $43 | 0.57% |
| THE HORTON GROUP3 Filed as: KRISTIN E HORTON | 6275 THEISEN ROAD ELMIRA, MI 49730 | AFLAC | $42 | — | $42 | 0.56% |
| SAMANTHA J AYBAR3 | 1317 TRIANDRA LN NAPLES, FL 34119 | AFLAC | $38 | — | $38 | 0.51% |
| AMY EVANS3 | 14358 MAGNOLIA BLVD APT 103 SHERMAN OAKS, CA 91423 | AFLAC | $38 | — | $38 | 0.51% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SRVC INC | P.O. BOX 632886 CINCINNATI, OH 45263 | AFLAC | $34 | — | $34 | 0.45% |
| STACIE L BENDER3 | 2406 WINDERMERE ST BAKERSFIELD, CA 93311 | AFLAC | $32 | — | $32 | 0.43% |
| LYNNE M HARVEY3 | 307 S MAPLE AVE GAYLORD, MI 49735 | AFLAC | $27 | — | $27 | 0.36% |
| CREATIVA ASSOCIATES FINANCIAL & INS3 Filed as: CREATIVA ASSOCIATES FINANCIAL AND I | 28470 AVENUE STANFORD STE 300 VALENCIA, CA 91355 | AFLAC | $27 | — | $27 | 0.36% |
| DUANE E CORDES3 | P.O. BOX 455 HILLMAN, MI 49746 | AFLAC | $25 | — | $25 | 0.33% |
| AMY N GEHLHAUSEN3 | 3115 HOWARD DR JASPER, IN 47546 | AFLAC | $24 | — | $24 | 0.32% |
| NATALIE K DAVIS3 | 1753 SNOW OWL COURT GAYLORD, MI 49735 | AFLAC | $22 | — | $22 | 0.29% |
| CBIZ BENEFITS & INSURANCE SERVICES3 Filed as: CBIZ BENEFITS AND INS SRVC INC | PO BOX 632886 CINCINNATI, OH 45263 | AFLAC | $21 | — | $21 | 0.28% |
| WENDY STOCK3 | 6829 FIRESTONE COURT GAYLORD, MI 49735 | AFLAC | $20 | — | $20 | 0.27% |
| DEBORAH L JONGES3 | P.O. BOX 31994 PALM BEACH GARDENS, FL 33420 | AFLAC | $19 | — | $19 | 0.25% |
| ALEXANDER G BAYER3 | 900 CAMINO REAL UNIT 202 REDONDO BEACH, CA 90277 | AFLAC | $18 | — | $18 | 0.24% |
| ALFRED RIETKERK3 | 3120 NE 47TH ST FT LAUDERDALE, FL 33308 | AFLAC | $18 | — | $18 | 0.24% |
| YOLANDA JOY RICHMAN3 | 10000 NEVADA AVE CHATSWORTH, CA 91311 | AFLAC | $17 | — | $17 | 0.23% |
| SOUZA INS SERVICES INC3 | 9407 ALMOND CREEK DR BAKERSFIELD, CA 93311 | AFLAC | $17 | — | $17 | 0.23% |
| KEVIN E GATLIN3 | PO BOX 402 MORAN, WY 83013 | AFLAC | $16 | — | $16 | 0.21% |
| JASON L GLICK3 | 7628 GRATIOT RD RM 101 SAGINAW, MI 48609 | AFLAC | $11 | — | $11 | 0.15% |
| BENJAMIN HUNTER3 | 11193 GUY ST FISHERS, IN 46038 | AFLAC | $10 | — | $10 | 0.13% |
| DAVID ANDREW PEPIN3 | 9341 FORT BAYARD AVE LAS VEGAS, NV 89178 | AFLAC | $9 | — | $9 | 0.12% |
| TRENTON FRANDSEN3 Filed as: TRENTON L FRANDSEN | 929 MEADOW LANE AVE CODY, WY 82414 | AFLAC | $9 | — | $9 | 0.12% |
| RENEE SUZANNE CORSO3 | 5805 SEPULVEDA BLVD STE 700 STE 740 SHERMAN OAKS, CA 91411 | AFLAC | $9 | — | $9 | 0.12% |
| JOSEPH A BUZZELLO3 | 9018 BALBOA BLVD SUITE 254 NORTHRIDGE, CA 91325 | AFLAC | $8 | — | $8 | 0.11% |
| JOHN P KOWN II3 | 1275 SHILOH ROAD NW SUITE 2260 KENNESAW, GA 30144 | AFLAC | $7 | — | $7 | 0.09% |
| COLE & COLE INS SVCS LLC3 | 5558 CALIFORNIA AVE STE 320 BAKERSFIELD, CA 93309 | AFLAC | $7 | — | $7 | 0.09% |
| JAYNE A STALLINGS3 | 8056 TIGER PALM WAY FORT MYERS, FL 33966 | AFLAC | $6 | — | $6 | 0.08% |
| BRADLEY J LOWRAN3 | 9553 E WALKABOUT LANE TRAVERSE CITY, MI 49684 | AFLAC | $6 | — | $6 | 0.08% |
| DOUGLAS E FOX3 Filed as: DOUGLAS EDWARD FOX | 6836 THAYER LAKE DR ALDEN, MI 49612 | AFLAC | $5 | — | $5 | 0.07% |
| DEXTER ANTONIO HARRIS3 | 100 GALLERIA PARKWAY SE STE 900 ATLANTA, GA 30339 | AFLAC | $5 | — | $5 | 0.07% |
| CHRIS A GEHLHAUSEN3 | 101 PLAZA EAST BLVD STE 317 EVANSVILLE, IN 47715 | AFLAC | $5 | — | $5 | 0.07% |
| JAYNE A STALLINGS3 | 8056 TIGER PALM WAY FORT MYERS, FL 33966 | AFLAC | $5 | — | $5 | 0.07% |
| CAMERON BELL3 | 2390 CRENSHAW BLVD STE 307 TORRANCE, CA 90501 | AFLAC | $5 | — | $5 | 0.07% |
| SHANNON DEON MERRITT3 | 4349 WEBB RD WOLVERINE, MI 49799 | AFLAC | $4 | — | $4 | 0.05% |
| DAVID C CLOUD JR3 | 12 TRENT DR SE ROME, GA 30161 | AFLAC | $4 | — | $4 | 0.05% |
| WARREN H FRANK JR3 | 301 HUGH STREET EAST JORDAN, MI 49727 | AFLAC | $4 | — | $4 | 0.05% |
| ANDREW K GLAUB3 | 6155 GRAEBEAR TRL EAST LANSING, MI 48823 | AFLAC | $4 | — | $4 | 0.05% |
| CHRISTOPHER EVANS3 | 5300 NEWCASTLE AVE APT 71 ENCINO, CA 91316 | AFLAC | $4 | — | $4 | 0.05% |
| LISA A NELSON3 | PO BOX 456 CADILLAC, MI 49601 | AFLAC | $3 | — | $3 | 0.04% |
| J THEIS & ASSOCIATES INC3 | 2048 OVERLAND AVE STE 202 BILLINGS, MT 59102 | AFLAC | $3 | — | $3 | 0.04% |
| MIELKE INSURANCE INC3 | PO BOX 26 CHARLEVOIX, MI 49720 | AFLAC | $3 | — | $3 | 0.04% |
| DANIEL COLE3 Filed as: DANIEL B COLE | 5558 CALIFORNIA AVE STE 320 BAKERSFIELD, CA 93309 | AFLAC | $3 | — | $3 | 0.04% |
| WILLIAM J CAMPBELL3 | PO BOX 66809 ST PETERSBURG BEACH, FL 33736 | AFLAC | $2 | — | $2 | 0.03% |
| RONALD A DASHKOVITZ3 | 20 MILLPOND TRL SAGINAW, MI 48603 | AFLAC | $2 | — | $2 | 0.03% |
| JOHN D TYLER3 | 2131 KILEY WAY EDMOND, OK 73034 | AFLAC | $2 | — | $2 | 0.03% |
| RICHARD J KUNZ3 | 601 MONTGOMERY ST STE 1475 SAN FRANCISCO, CA 94111 | AFLAC | $2 | — | $2 | 0.03% |
| TRACY E BIELACZYC3 | 1621 PINCHERRY RD TRAVERSE CITY, MI 49696 | AFLAC | $2 | — | $2 | 0.03% |
| BENJAMIN HUNTER3 | 18401 AVEBURY LN WESTFIELD, IN 46062 | AFLAC | $2 | — | $2 | 0.03% |
| CAMERON J BELL3 | 2390 CRENSHAW BLVD STE 307 TORRANCE, CA 90501 | AFLAC | $2 | — | $2 | 0.03% |
| ADAM H MICHAELS3 | 2922 CORDA LN LOS ANGELES, CA 90049 | AFLAC | $2 | — | $2 | 0.03% |
| STEPHANIE L KESSELRING3 | 3141 ROLLING GREEN CT MILFORD, MI 48380 | AFLAC | $1 | — | $1 | 0.01% |
| HEATHER A DOLLIVER3 | 2150 ASSOCIATION DR OKEMOS, MI 48864 | AFLAC | $1 | — | $1 | 0.01% |
| JEFFREY C WERNER3 | 6370 PINE HOLLOW DR EAST LANSING, MI 48823 | AFLAC | $1 | — | $1 | 0.01% |
| SUSAN P WATLEY3 | 6366 INDEPENDENCE DR COLUMBUS, GA 31909 | AFLAC | $1 | — | $1 | 0.01% |
| WILLIS TOWERS WATSON US LLC3 Filed as: JOSEPH H WILLIS JR | 1431 NE 55TH ST FORT LAUDERDALE, FL 33334 | AFLAC | $1 | — | $1 | 0.01% |
| LARA K GRANDE3 | 117 MORNING MIST LN FRANKLIN, TN 37064 | AFLAC | $1 | — | $1 | 0.01% |
| J THEIS & ASSOCIATES INC3 | 2048 OVERLAND AVE SUITE 202 BILLINGS, MT 59102 | AFLAC | $1 | — | $1 | 0.01% |
| ANNIE GLAUB3 | 6155 GRAEBEAR TRL EAST LANSING, MI 48823 | AFLAC | $1 | — | $1 | 0.01% |
| RANDALL L KIMBLER3 | PO BOX 302 HESPERIA, MI 49421 | AFLAC | $1 | — | $1 | 0.01% |
| GREGORY CRAWFORD3 | PO BOX 413 MIDLAND, MI 48640 | AFLAC | $1 | — | $1 | 0.01% |
| CASEY DALE HOBSON3 | 13320 W REDWICK DR BOISE, ID 83713 | AFLAC | $1 | — | $1 | 0.01% |
| DAWN D SHEUE3 | PO BOX 3986 JACKSON, WY 83001 | AFLAC | $1 | — | $1 | 0.01% |
| JAMES M FLETCHER3 | 254 JOHN ST AURORA, IN 47001 | AFLAC | $1 | — | $1 | 0.01% |
| DANIEL M WOLF3 | PO BOX 601 MARQUETTE, MI 49855 | AFLAC | $1 | — | $1 | 0.01% |
| LARA K GRANDE3 | 1022 WESTHAVEN BLVD FRANKLIN, TN 37064 | AFLAC | $1 | — | $1 | 0.01% |
| DEBORAH B SMITH3 | 5703 BRYNWOOD CIR NW ACWORTH, GA 30101 | AFLAC | $1 | — | $1 | 0.01% |
| BRIAN G JAEGGI3 | 15607 W LILLI WAY VAN NUYS, CA 91406 | AFLAC | $1 | — | $1 | 0.01% |
| CHRISTOPHER HAGER3 | 8021 TRUXTON AVE LOS ANGELES, CA 90045 | AFLAC | $1 | — | $1 | 0.01% |
| JOSEPH A BUZZELLO3 | 9018 BALBOA BLVD STE 254 NORTHRIDGE, CA 91325 | AFLAC | $1 | — | $1 | 0.01% |
| CREATIVA ASSOCIATES FINANCIAL & INS3 | 28470 AVENUE STANFORD SUITE 300 VALENCIA, CA 91355 | DELTA DENTAL OF CALIFORNIA | $3 | — | $3 | 8.57% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM BLUE CROSS LIFE AND HEALTH I EIN 95-4331852 MED CLAIM ADMIN | Claims processing; Float revenue; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other fees; Other services Service code 12 | — | $476K |
| DELTA DENTAL OF CALIFORNIA EIN 94-1461312 DENTAL CLAIM ADMIN | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | — | $58K |
| PRUDENTIAL INSURANCE COMPANY OF AME EIN 22-1211670 FMLA ADMIN | Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Direct payment from the plan; Participant communication; Other services; Contract Administrator Service code 12 | — | $25K |
| COMPSYCH | Direct payment from the plan; Claims processing; Contract Administrator; Participant communication Service code 12 | — | $4K |
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 | 516 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 29 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 545 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 119 | $621K |
| Dental | DELTA DENTAL OF CALIFORNIA | 0 | $35 |
| Vision | VISION SERVICE PLAN | 516 | $101K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 516 | $1.1M |
| Short-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 516 | $1.1M |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 516 | $1.1M |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 119 | $621K |
| Stop-loss / reinsurancereinsurance | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 461 | $764K |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 516 | $1.1M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 516 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.