# GROCERY OUTLET, INC. HEALTH & WELFARE PLAN

Health and welfare plan sponsored by **GROCERY OUTLET, INC.**. Form 5500 filing for plan year 2025.

| Field | Value |
|---|---|
| Sponsor | GROCERY OUTLET, INC. |
| EIN | 941513561 |
| Plan number | 501 |
| Plan year | 2025 |
| Location | EMERYVILLE, CA |
| Industry | retail |
| Funding | mixed |
| Total premiums | $5.5M |
| Participants | 1,499 |
| Persons covered | 1,499 |

## Insurance carriers (Schedule A)

| Carrier | Coverage |
|---|---|
| KAISER PERMANENTE | Health, Rx, HMO |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | Life, STD, LTD, Other |
| VISION SERVICE PLAN (VSP) | Vision |
| AFLAC | Other |

## Brokers

| Broker | Placed with |
|---|---|
| RELATION INSURANCE SERVICES OF CA | KAISER FOUNDATION HEALTH PLAN, INC. |
| RELATION INSURANCE SERVICES OF CA | THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA |
| CENTRO BENEFITS RESEARCH LLC | VISION SERVICE PLAN |
| RELATION INSURANCE SERVICES OF CA | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON |
| ARACELIA PEDRO | AFLAC |
| RELATIONS INSURANCE SERVICES | AFLAC |
| ERIC N RAWLINGS | AFLAC |
| RONDA MATHEW | AFLAC |
| DEBORAH L SENN | AFLAC |
| GUILLERMO H PALOMINO | AFLAC |
| SAHAR QABAZARD | AFLAC |

## About this data

- Source: public Form 5500 filings from the U.S. Department of Labor (EBSA), rebuilt on each DOL release.
- Full page (charts, history, peer benchmarks, fees, contacts): https://planoptica.com/welfare/941513561-501
- Cite as: PlanOptica, https://planoptica.com/welfare/941513561-501
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