| 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 | $52K | — | $52K | 0.86% |
| CREATIVA ASSOCIATES FINANCIAL & INS3 | 28470 AVENUE STANFORD SUITE 300 VALENCIA, CA 91355 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $36K | — | $36K | 10.00% |
| SETH JAFFE3 | 4127 E MASSACHUSETTS ST LONG BEACH, CA 90814 | AFLAC | $10K | $738 | $11K | 6.84% |
| CREATIVA ASSOCIATES FINANCIAL & INS3 | 28470 AVENUE STANFORD SUITE 300 VALENCIA, CA 91355 | AFLAC | $4K | — | $4K | 2.46% |
| JOSEPH J DERTHICK3 Filed as: JOSEPH DERTHICK | 15428 FLATBUSH AVE NORWALK, CA 90650 | AFLAC | $2K | — | $2K | 1.57% |
| H HOWARD THOMSON3 | 65 PINE AVE SUITE 102 LONG BEACH, CA 90802 | AFLAC | $2K | — | $2K | 1.55% |
| JESSICA PEREZ3 | 11835 W OLYMPIC BLVD STE 795E LOS ANGELES, CA 90064 | AFLAC | $1K | $156 | $1K | 0.92% |
| KYLE ROBERT BUTTERMORE3 | 13603 MARINA POINTE DR APT C331 MARINA DEL REY, CA 90292 | AFLAC | $998 | — | $998 | 0.64% |
| CLAY W CAMPBELL3 | 14720 LIBLEN AVE BELLFLOWER, CA 90706 | AFLAC | $950 | — | $950 | 0.61% |
| PATRICIA GAIL LEES3 | 6055 E WASHINGTON BLVD SUITE 210 COMMERCE, CA 90040 | AFLAC | $653 | — | $653 | 0.42% |
| ALFRED RIETKERK3 | 3120 NE 47TH ST FT LAUDERDALE, FL 33308 | AFLAC | $550 | — | $550 | 0.35% |
| CHARLES RENICO3 | 1127 HACIENDA PL APT 4 WEST HOLLYWOOD, CA 90069 | AFLAC | $385 | $139 | $524 | 0.33% |
| PATRICIA D SLEDGE3 | 25586 18TH ST SAN BERNARDINO, CA 92404 | AFLAC | $430 | — | $430 | 0.27% |
| DAVID J REESOR3 | 2220 E ROUTE 66 STE 215 GLENDORA, CA 91740 | AFLAC | $220 | — | $220 | 0.14% |
| KRISTOPHER KEAHIOLALO3 | 725 KAPIOLANI BLVD STE C302 HONOLULU, HI 96813 | AFLAC | $139 | — | $139 | 0.09% |
| KATHLEEN S HANSON3 | 5460 E EL PARQUE ST LONG BEACH, CA 90815 | AFLAC | $128 | — | $128 | 0.08% |
| ALEJANDRO ORANTES3 | PO BOX 243 MONTEBELLO, CA 90640 | AFLAC | $122 | — | $122 | 0.08% |
| RAVONE MARVELLE GRAHAM3 | 7601 ARCADIA TRL FORT WORTH, TX 76137 | AFLAC | $102 | — | $102 | 0.07% |
| DE VITA B MCKENZIE3 | 300 E ESPLANADE DR STE 1220 OXNARD, CA 93036 | AFLAC | $92 | — | $92 | 0.06% |
| BARRY MCPHERSON INC3 | 2211 MICHELSON DR SUITE 1150 IRVINE, CA 92612 | AFLAC | $81 | — | $81 | 0.05% |
| RAVONE MARVELLE GRAHAM3 | 23972 OLD POMEGRANATE RD YORBA LINDA, CA 92887 | AFLAC | $59 | — | $59 | 0.04% |
| JOANNA G MATHERLY3 | 2000 GLEN ECHO RD STE 204 NASHVILLE, TN 37215 | AFLAC | $54 | — | $54 | 0.03% |
| VALERIE LYNN VEGA3 | 4127 E MASSACHUSETTS ST LONG BEACH, CA 90814 | AFLAC | $41 | — | $41 | 0.03% |
| OWEN JOHNSTON3 | 796 N HART ST ORANGE, CA 92867 | AFLAC | $32 | — | $32 | 0.02% |
| RASA REYNOLDS3 | 6716 CLYBOURN AVE UNIT 201 NORTH HOLLYWOOD, CA 91606 | AFLAC | $25 | — | $25 | 0.02% |
| JAMES P BOADA3 | 30991 VIA MIRADOR SAN JUAN CAPISTRANO, CA 92675 | AFLAC | $23 | — | $23 | 0.01% |
| KRISTEN NICOLE GLENN3 | 1604 VIA TULIPAN SAN CLEMENTE, CA 92673 | AFLAC | $20 | — | $20 | 0.01% |
| DALE I DAVIS3 | 5892 CEDARCREEK LN LEXINGTON, KY 40515 | AFLAC | $19 | — | $19 | 0.01% |
| BETTY MURDOCK3 | 7216 TESSERA PKWY LAGO VISTA, TX 78645 | AFLAC | $14 | — | $14 | 0.01% |
| OSCAR FREGOSO3 | 3324 W VERDUGO AVE BURBANK, CA 91505 | AFLAC | $13 | — | $13 | 0.01% |
| JONATHAN ALI HAJIMOMEN3 | 1561 E ORANGETHORPE AVE STE 200 FULLERTON, CA 92831 | AFLAC | $13 | — | $13 | 0.01% |
| DALE I DAVIS3 | 1856 TRAVELLER RD LEXINGTON, KY 40504 | AFLAC | $12 | — | $12 | 0.01% |
| KAYLA MULLIGAN3 | 10523 VALPARAISO ST LOS ANGELES, CA 90034 | AFLAC | $11 | — | $11 | 0.01% |
| ANDREA M MACIAS3 | 7216 TESSERA PKWY LAGO VISTA, TX 78645 | AFLAC | $10 | — | $10 | 0.01% |
| SHAWN M GLENN3 | 1604 VIA TULIPAN SAN CLEMENTE, CA 92673 | AFLAC | $7 | — | $7 | 0.00% |
| STEVEN R HANSON3 | 340 E 2ND STREET SUITE 310 LOS ANGELES, CA 90012 | AFLAC | $7 | — | $7 | 0.00% |
| G SCOTT COOKE3 | 2832 NE 17TH AVE WILTON MANORS, FL 33334 | AFLAC | $6 | — | $6 | 0.00% |
| TODD V MASON3 | 6164 LAWRENCE ST CYPRESS, CA 90630 | AFLAC | $5 | — | $5 | 0.00% |
| 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 | 11739 HICKORY RUN CT LOVELAND, OH 45140 | AFLAC | $3 | — | $3 | 0.00% |
| HENRY SAUCEDA3 | 2268 ALPHA CIR LA VERNE, CA 91750 | AFLAC | $2 | — | $2 | 0.00% |
| IOANNIS T GRATSINOPOULOS3 | 1893 E DAULBY ST MERIDIAN, ID 83642 | AFLAC | $1 | — | $1 | 0.00% |
| IOANNIS T GRATSINOPOULOS3 | 3565 SUMMERLINN DR WEST LINN, OR 97068 | AFLAC | $1 | — | $1 | 0.00% |
| JOSEPH A BUZZELLO3 | 9018 BALBOA BLVD STE 254 NORTHRIDGE, CA 91325 | AFLAC | $1 | — | $1 | 0.00% |
| MICHAEL C WALKER3 Filed as: MICHAEL A STACHOWIAK | 321 N CLARK ST STE 615 CHICAGO, IL 60654 | AFLAC | $1 | — | $1 | 0.00% |
| KRISTIN BEAN3 | 5058 HAWLEY BLVD SAN DIEGO, CA 92116 | AFLAC | $1 | — | $1 | 0.00% |
| MICHAEL C WALKER3 Filed as: MICHAEL A STACHOWIAK | 321 N CLARK ST STE 625 CHICAGO, IL 60654 | AFLAC | $1 | — | $1 | 0.00% |
| MICHAEL R. FISHER3 Filed as: MICHAEL R FISHER | 50 W LEMON AVE STE 2 MONROVIA, CA 91016 | AFLAC | $1 | — | $1 | 0.00% |
| CREATIVA ASSOCIATES FINANCIAL & INS3 Filed as: CREATIVA ASSOCIATES FINANCIAL AND I | 28470 AVENUE STANFORD SUITE 300 VALENCIA, CA 91355 | VISION SERVICE PLAN | $10K | — | $10K | 9.13% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 CLAIM ADMIN MED & RX | Direct payment from the plan; Float revenue; Other services; Contract Administrator; Participant communication; Named fiduciary; Non-monetary compensation; Claims processing Service code 12 | — | $974K |
| PRUDENTIAL EIN 22-1211670 CLAIM ADMIN EAP | Participant communication; Direct payment from the plan; Contract Administrator; Claims processing Service code 12 | — | $17 |
| CIGNA | Participant communication; Claims processing; Other services; Float revenue; Direct payment from the plan; Non-monetary compensation; Contract Administrator; Named fiduciary Service code 12 | — | $0 |
| COMPSYCH EIN 35-3739783 CLAIM ADMIN EAP | Claims processing; Direct payment from the plan; Participant communication; Contract Administrator 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 | 804 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 806 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTHCARE OF CALIFORNIA | 1,512 | $6.0M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,512 | $1.8M |
| Vision | VISION SERVICE PLAN | 522 | $105K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 804 | $359K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 804 | $359K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,512 | $1.8M |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 804 | $516K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,512 | — |
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."
No prospect flags tripped on this filing.