| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| UNIFIED GROCERS INSURANCE SERVICES3 Filed as: UNIFIED GROCERS INS. SERVICES INC. | 874 SOUTH VILLAGE OAKS DRIVE COVINA, CA 917243614 | KAISER FOUNDATION HEALTH PLAN INC | $96K | — | $96K | 2.99% |
| UNIFIED GROCERS INSURANCE SERVICES3 Filed as: UNIFIED GROCERS INS. SERVICES, INC. | 874 SOUTH VILLAGE OAKS DRIVE COVINA, CA 917243614 | KAISER FOUNDATION HEALTH PLAN INC | $22K | — | $22K | 2.88% |
| UNIFIED GROCERS INSURANCE SERVICES3 Filed as: UNIFIED GROCERS INS. SERVICES, INC. | 874 SOUTH VILLAGE OAKS DRIVE COVINA, CA 91724 | KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | $10K | — | $10K | 1.94% |
| UNIFIED GROCERS INSURANCE3 | 874 S VILLAGE OAKS DR COVINA, CA 91724 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $52K | — | $52K | 9.99% |
| UNIFIED GROCERS INSURANCE SERVICES3 Filed as: UNIFIED GROCERS INS. SERVICES, INC. | 874 SOUTH VILLAGE OAKS DRIVE COVINA, CA 91724 | GROUP HEALTH OPTIONS, INC. | $10K | — | $10K | 3.39% |
| WILLIS TOWERS WATSON US LLC4 Filed as: TOWERS WATSON DELAWARE INC | PO BOX 28852 NEW YORK, NY 100878852 | VISION SERVICE PLAN | $1K | — | $1K | 0.70% |
| WILLIS TOWERS WATSON US LLC4 Filed as: TOWERS WATSON PENNSYLVANIA | PO BOX 8500 STOP 9102 PHILADELPHIA, PA 191789102 | VISION SERVICE PLAN | $108 | — | $108 | 0.06% |
| UNIFIED GROCERS INSURANCE SERVICES3 | 874 S VILLAGE OAKS DR COVINA, CA 91724 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $17K | — | $17K | 10.00% |
| UNIFIED GROCERS INSURANCE SERVICES3 | 874 S VILLAGE OAKS DR COVINA, CA 91724 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $15K | — | $15K | 10.00% |
| UNIFIED GROCERS INSURANCE3 Filed as: UNIFIED GROCERS INSURANCE SVCS | 874 S VILLAGE OAKS DR COVINA, CA 91724 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $18K | — | $18K | 15.18% |
| UNIFIED GROCERS INSURANCE SERVICES3 Filed as: UNIFIED GROCERS INS. SERVICES, INC. | 874 S VILLAGE OAKS DRIVE COVINA, CA 91724 | NATIONAL UNION FIRE INSURANCE CO OF PITTSBURGH, PA | $8K | — | $8K | 15.00% |
| UNIFIED GROCERS INSURANCE SERVICES3 Filed as: UNIFIED GROCERS INS. SERVICES, INC. | P.O. BOX 4193 COVINA, CA 917230593 | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | $1K | — | $1K | 5.02% |
| UNIFIED GROCERS INSURANCE3 | 874 S VILLAGE OAKS DR COVINA, CA 91724 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $2K | — | $2K | 10.00% |
| UNIFIED GROCERS INSURANCE SERVICES3 Filed as: UNIFIED GROCERS INS SERVICES INC | 874 SOUTH VILLAGE OAKS DRIVE COVINA, CA 91724 | HARTFORD LIFE AND ACCIDENT | $1K | — | $1K | 15.00% |
| UNIFIED GROCERS INSURANCE SERVICES3 Filed as: UNIFIED GROCERS INS. SERVICES, INC. | PO BOX 30398 LOS ANGELES, CA 90030 | HARTFORD LIFE AND ACCIDENT | $481 | — | $481 | 15.01% |
No Schedule C service providers reported on this filing.
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 | 1,068 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 12 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,080 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 588 | $4.8M |
| Dental | SAFEGUARD HEALTH PLANS, INC., A CALIFORNIA CORPORATION | 173 | $23K |
| Vision | VISION SERVICE PLAN | 980 | $176K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,087 | $517K |
| Short-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 1,042 | $166K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 1,042 | $151K |
| Prescription drug(4 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN INC | 588 | $4.3M |
| Stop-loss / reinsurancereinsurance | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | 1,472 | $373K |
| Other(6 contracts, 4 carriers) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 1,087 | $722K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,472 | — |
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.