| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CREATIVA ASSOCIATES FINANCIAL & INS3 Filed as: CREATIVA ASSOCIATES | 28470 AVENUE STANFORD SUITE 300 VALENCIA, CA 91355 | CIGNA HEALTHCARE OF CALIFORNIA | $47K | — | $47K | 0.89% |
| CREATIVA ASSOCIATES FINANCIAL & INS3 | 28470 AVENUE STANFORD SUITE 300 VALENCIA, CA 91355 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $20K | — | $20K | 10.00% |
| SETH JAFFE3 | 4127 E. MASSACHUSETTS ST LONG BEACH, CA 90814 | AFLAC | $4K | $465 | $4K | 3.12% |
| H HOWARD THOMSON3 | 65 PINE AVE SUITE 102 LONG BEACH, CA 90802 | AFLAC | $4K | — | $4K | 2.90% |
| JOSEPH J DERTHICK3 | 15428 FLATBUSH AVE NORWALK, CA 90650 | AFLAC | $4K | $52 | $4K | 2.90% |
| CREATIVA ASSOCIATES FINANCIAL & INS3 | 28470 AVENUE STANFORD SUITE 300 VALENCIA, CA 91355 | AFLAC | $4K | $5 | $4K | 2.62% |
| PATRICIA GAIL LEES3 | 6055 E WASHINGTON BLVD SUITE 955 COMMERCE, CA 90040 | AFLAC | $2K | $103 | $2K | 1.59% |
| CLAY W CAMPBELL3 | 14720 LIBLEN AVE BELLFLOWER, CA 90706 | AFLAC | $2K | — | $2K | 1.12% |
| VALERIE LYNN VEGA3 | 4127 E MASSACHUSETTS ST LONG BEACH, CA 90814 | AFLAC | $1K | — | $1K | 0.91% |
| ALFRED RIETKERK3 | 3120 NE 47TH ST FT LAUDERDALE, FL 33308 | AFLAC | $877 | — | $877 | 0.64% |
| PATRICIA D SLEDGE3 | 1210 TRIBUNE ST REDLANDS, CA 92374 | AFLAC | $671 | — | $671 | 0.49% |
| RAVONE MARVELLE GRAHAM3 | 4621 BRIARHILL DR YORBA LINDA, CA 92886 | AFLAC | $251 | $97 | $348 | 0.25% |
| BARRY MCPHERSON INC3 | 2211 MICHELSON DR SUITE 1150 IRVINE, CA 92612 | AFLAC | $153 | $99 | $252 | 0.18% |
| SETH JAFFE3 | 4127 E MASSACHUSETTS ST LONG BEACH, CA 90814 | AFLAC | $232 | — | $232 | 0.17% |
| KATHLEEN S HANSON3 | 2581 HILLCREST ST SIGNAL HILL, CA 90755 | AFLAC | $196 | — | $196 | 0.14% |
| ALEJANDRO ORANTES3 | PO BOX 243 MONTEBELLO, CA 90640 | AFLAC | $139 | — | $139 | 0.10% |
| SETH JAFFE3 | 4127 E MASSACHUSETTS ST LONG BEACH, CA 90814 | AFLAC | $105 | — | $105 | 0.08% |
| BETTY MURDOCK3 | 2980 FLORINE AVE RIVERSIDE, CA 92509 | AFLAC | $65 | — | $65 | 0.05% |
| MARITZA A VAZQUEZ3 | 3564 BURNING TREE DR ONTARIO, CA 91761 | AFLAC | $40 | — | $40 | 0.03% |
| ANDREA M MACIAS3 | 2980 FLORINE AVE RIVERSIDE, CA 92509 | AFLAC | $37 | — | $37 | 0.03% |
| TERESA WATSON REED3 | 13785 CHAPARRAL AVE FONTANA, CA 92337 | AFLAC | $33 | — | $33 | 0.02% |
| ACEVES INSURANCE SERVICES INC.3 Filed as: ACEVES INSURANCE SERVICES INC | 9959 BROOKSHIRE AVE DOWNEY, CA 90240 | AFLAC | $30 | — | $30 | 0.02% |
| TERRANCE M LUCZAJ3 | 1201 MAIN ST SUITE 2300 COLUMBIA, SC 29201 | AFLAC | $25 | — | $25 | 0.02% |
| BARBARA JEAN WITCHER3 | 27126 PINARIO MISSION VIEJO, CA 92692 | AFLAC | $20 | — | $20 | 0.01% |
| KRISTEN NICOLE GLENN3 | 1604 VIA TULIPAN SAN CLEMENTE, CA 92673 | AFLAC | $20 | — | $20 | 0.01% |
| DAVID J REESOR3 | 2001 E FINANCIAL WAY STE 201 GLENDORA, CA 91741 | AFLAC | $19 | — | $19 | 0.01% |
| GARY W WARE JR3 | 2306 VALLEYBROOK DR CHAMPAIGNE, IL 61822 | AFLAC | $13 | — | $13 | 0.01% |
| TODD V MASON3 | 6164 LAWRENCE ST CYPRESS, CA 90630 | AFLAC | $11 | — | $11 | 0.01% |
| SHAWN M GLENN3 | 1604 VIA TULIPAN SAN CLEMENTE, CA 92673 | AFLAC | $7 | — | $7 | 0.01% |
| PEGGY K SALMON3 | 2203 AVENIDA OLIVA SAN CLEMENTE, CA 92673 | AFLAC | $5 | — | $5 | 0.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 28202 CABOT RD STE 600 LAGUNA NIGUEL, CA 92677 | AFLAC | $3 | — | $3 | 0.00% |
| ANDREW R GRETHEL3 | 600 S HIDDEN VALLEY RD #150 CARLSBAD, CA 92011 | AFLAC | $3 | — | $3 | 0.00% |
| CREATIVA ASSOCIATES FINANCIAL & INS3 Filed as: CREATIVA ASSOCIATES | 28470 AVENUE STANFORD SUITE 300 VALENCIA, CA 91355 | VISION SERVICE PLAN | $9K | — | $9K | 10.00% |
| CREATIVA ASSOCIATES FINANCIAL & INS3 | 28470 AVENUE STANFORD STE 300 VALENCIA, CA 91355 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $3K | — | $3K | 10.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 CLAIM ADMIN MED & RX | Float revenue; Other services; Claims processing; Non-monetary compensation; Direct payment from the plan; Participant communication; Named fiduciary; Contract Administrator Service code 12 | — | $556K |
| PRUDENTIAL EIN 22-1211670 CLAIM ADMIN EAP | Direct payment from the plan; Contract Administrator; Claims processing; Participant communication Service code 12 | — | $2 |
| CIGNA | Claims processing; Contract Administrator; Float revenue; Non-monetary compensation; Named fiduciary; Participant communication; Direct payment from the plan; Other services Service code 12 | — | $0 |
| COMPSYCH EIN 35-3739783 CLAIM ADMIN EAP | Contract Administrator; Participant communication; Direct payment from the plan; Claims processing Service code 12 | — | $0 |
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 | 709 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 714 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | CIGNA HEALTHCARE OF CALIFORNIA | 619 | $6.7M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 619 | $1.5M |
| Vision | VISION SERVICE PLAN | 436 | $87K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 709 | $204K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 280 | $25K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 619 | $1.5M |
| Other | AFLAC | 228 | $137K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 709 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.