| 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 | $48K | — | $48K | 0.73% |
| CREATIVA ASSOCIATES FINANCIAL & INS3 | 28470 AVENUE STANFORD SUITE 300 VALENCIA, CA 91355 | PRUDENTIAL INSURANCE COMPANY OF AMERICA | $42K | — | $42K | 10.00% |
| SETH JAFFE3 Filed as: SETH L JAFFE | 4127 E MASSACHUSETTS ST LONG BEACH, CA 90814 | AFLAC | $5K | — | $5K | 3.87% |
| H HOWARD THOMSON3 | 14938 BARNWALL ST LA MIRADA, CA 90638 | AFLAC | $2K | — | $2K | 1.48% |
| JOSEPH J DERTHICK3 | 15428 FLATBUSH AVE NORWALK, CA 90650 | AFLAC | $2K | — | $2K | 1.47% |
| CREATIVA ASSOCIATES FINANCIAL & INS3 | 28470 AVENUE STANFORD SUITE 300 VALENCIA, CA 91355 | AFLAC | $2K | — | $2K | 1.43% |
| CLAY W CAMPBELL3 | 14720 LIBLEN AVE BELLFLOWER, CA 90706 | AFLAC | $804 | — | $804 | 0.58% |
| JESSICA PEREZ3 | 6167 BRISTOL PKWY STE 106 CULVER CITY, CA 90230 | AFLAC | $581 | — | $581 | 0.42% |
| PATRICIA GAIL LEES3 | 1124 CHURCHS CT BURBANK, CA 91501 | AFLAC | $493 | — | $493 | 0.35% |
| ALFRED RIETKERK3 | 438 PISGAH PIKE PULASKI, TN 38478 | AFLAC | $465 | — | $465 | 0.33% |
| PATRICIA D SLEDGE3 | 25586 18TH ST SAN BERNARDINO, CA 92404 | AFLAC | $354 | — | $354 | 0.25% |
| KYLE ROBERT BUTTERMORE3 | 5464 YARMOUTH AVE APT 14 ENCINO, CA 91316 | AFLAC | $324 | — | $324 | 0.23% |
| JULIE S KRAUS3 | 15066 VARSITY ST APT B MOORPARK, CA 93021 | AFLAC | $224 | — | $224 | 0.16% |
| CHARLES RENICO3 | 1127 HACIENDA PL APT 4 WEST HOLLYWOOD, CA 90069 | AFLAC | $218 | — | $218 | 0.16% |
| DAVID J REESOR3 | 1615 WILSON AVE UPLAND, CA 91784 | AFLAC | $179 | — | $179 | 0.13% |
| ALEJANDRO ORANTES3 | 11547 BEVERLY BLVD WHITTIER, CA 90601 | AFLAC | $118 | — | $118 | 0.08% |
| RAVONE MARVELLE GRAHAM3 | 7601 ARCADIA TRL FORT WORTH, TX 76137 | AFLAC | $109 | — | $109 | 0.08% |
| KATHLEEN S HANSON3 | 5460 E EL PARQUE ST LONG BEACH, CA 90815 | AFLAC | $107 | — | $107 | 0.08% |
| KRISTOPHER KEAHIOLALO3 | 531 HAHAIONE ST APT 11A HONOLULU, HI 96825 | AFLAC | $103 | — | $103 | 0.07% |
| VALERIE LYNN VEGA3 | 4127 E MASSACHUSETTS ST LONG BEACH, CA 90814 | AFLAC | $95 | — | $95 | 0.07% |
| DE VITA B MCKENZIE3 | 1139 IROLO ST LOS ANGELES, CA 90006 | AFLAC | $79 | — | $79 | 0.06% |
| BARRY MCPHERSON INC3 | 3928 IRONBARK WAY MCKINNEY, TX 75071 | AFLAC | $59 | — | $59 | 0.04% |
| AMY SLOKAN3 | 4413 HESSITE LOOP COLORADO SPRINGS, CO 80938 | AFLAC | $54 | — | $54 | 0.04% |
| JOANNA G MATHERLY3 | 2000 GLEN ECHO RD STE 204 NASHVILLE, TN 37215 | AFLAC | $46 | — | $46 | 0.03% |
| JACOB BURNS INC.3 Filed as: JACOB BURNS INC | 2905 MAGNOLIA AVE LONG BEACH, CA 90806 | AFLAC | $40 | — | $40 | 0.03% |
| DREW GRABINER3 | 201 PALOMA AVE LONG BEACH, CA 90803 | AFLAC | $36 | — | $36 | 0.03% |
| RASA REYNOLDS3 | 6716 CLYBOURN AVE UNIT 201 NORTH HOLLYWOOD, CA 91606 | AFLAC | $27 | — | $27 | 0.02% |
| JAMES P BOADA3 | 25501 PURPLE SAGE LN SAN JUAN CAPISTRANO, CA 92675 | AFLAC | $26 | — | $26 | 0.02% |
| DALE IRA DAVIS3 | 5892 CEDARCREEK LN LEXINGTON, KY 40515 | AFLAC | $23 | — | $23 | 0.02% |
| OWEN JOHNSTON3 | 1231 W 2ND ST SANTA ANA, CA 92703 | AFLAC | $23 | — | $23 | 0.02% |
| OSCAR FREGOSO3 | 25750 LEWIS WAY STEVENSON RANCH, CA 91381 | AFLAC | $14 | — | $14 | 0.01% |
| JONATHAN ALI HAJIMOMEN3 | 6540 GRAND MANAN DR CYPRESS, CA 90630 | AFLAC | $14 | — | $14 | 0.01% |
| BETTY MURDOCK3 | 7216 TESSERA PKWY LAGO VISTA, TX 78645 | AFLAC | $9 | — | $9 | 0.01% |
| ANDREA M MACIAS3 | 7216 TESSERA PKWY LAGO VISTA, TX 78645 | AFLAC | $7 | — | $7 | 0.01% |
| STEVEN R HANSON3 | 340 E 2ND STREET SUITE 310 LOS ANGELES, CA 90012 | AFLAC | $7 | — | $7 | 0.01% |
| KAYLA MULLIGAN3 | 5113 WHITMAN WAY APT 108 CARLSBAD, CA 92008 | AFLAC | $6 | — | $6 | 0.00% |
| G SCOTT COOKE3 | 2832 NE 17TH AVE WILTON MANORS, FL 33334 | AFLAC | $6 | — | $6 | 0.00% |
| TODD V MASON3 | 1607 W PACIFIC COAST HWY APT 144 WILMINGTON, CA 90744 | AFLAC | $4 | — | $4 | 0.00% |
| HENRY SAUCEDA3 | 2268 ALPHA CIR LA VERNE, CA 91750 | AFLAC | $2 | — | $2 | 0.00% |
| MICHAEL C WALKER3 Filed as: MICHAEL A STACHOWIAK | 321 N CLARK ST STE 615 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 | $11K | — | $11K | 9.97% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 CLAIM ADMIN MED & RX | Claims processing; Contract Administrator; Direct payment from the plan; Participant communication; Float revenue; Other services; Non-monetary compensation; Named fiduciary Service code 12 | — | $640K |
| CENTIVO T HOLDINGS, LLC EIN 30-1095511 CLAIM ADMIN MED | Named fiduciary; Contract Administrator; Participant communication; Direct payment from the plan; Claims processing Service code 12 | — | $21K |
| WITHME HEALTH EIN 83-0674605 CLAIM ADMIN RX | Named fiduciary; Contract Administrator; Participant communication; Direct payment from the plan; Claims processing Service code 12 | — | $2K |
| PRUDENTIAL EIN 22-1211670 CLAIM ADMIN EAP | Participant communication; Direct payment from the plan; Claims processing; Contract Administrator Service code 12 | — | $5 |
| CIGNA | Float revenue; Claims processing; Non-monetary compensation; Direct payment from the plan; Named fiduciary; Participant communication; Other services; Contract Administrator 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 | 836 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 9 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 845 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | CIGNA HEALTHCARE OF CALIFORNIA | 1,096 | $6.6M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,438 | $2.2M |
| Vision | VISION SERVICE PLAN | 578 | $114K |
| Life insurance | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 837 | $419K |
| Long-term disability | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 837 | $419K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,438 | $2.2M |
| Other(2 contracts, 2 carriers) | PRUDENTIAL INSURANCE COMPANY OF AMERICA | 837 | $559K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,438 | — |
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.