Form 5500 · Employee benefit plan · CONCORD, CA

UFCW & EMPLOYERS BENEFIT TRUST

Name: UFCW & EMPLOYERS BENEFIT TRUST — Form 5500 benefit plan
Creator: Form5500Lookup
License: https://www.usa.gov/government-works

UFCW & EMPLOYERS BENEFIT TRUST of CONCORD, CA is a 25,895-participant retail employer whose group benefits are disclosed in its annual Form 5500 filing. Its broker of record is CARL W. ROMSTADT. Coverage is written through KAISER FOUNDATION HEALTH PLAN, INC. and 2 other carriers. The plan's most recent policy period ended in December.

Benefits broker of record

CARL W. ROMSTADT

Insurance carrier

KAISER FOUNDATION HEALTH PLAN, INC.

Policy year ends

Decemberas filed for plan year 2024

Sourced from U.S. DOL EFAST2 Form 5500 · EIN 94-6078804 · plan 502 · plan year 2024, filed Oct 17, 2025

Get an email when this employer files a new Form 5500, and again about four months before its plan renews.

5,257 other employer plans in California have policy years ending in December. See the full list on the renewal calendar, or ask for it in Claude or ChatGPT.

How this plan is funded

Fully insured as reported

The plan's own financial statement reports paying insurance carriers about what the insurance contracts report in premium.

All participants at the start of the year

25,895

Active at start of year

25,895

Active at end of year

25,845

Disclosed commissions

$1,162

Typical renewal

January 1

Benefits declared on this filing

Healthinsured — KAISER FOUNDATION HEALTH PLAN, INC.16,171 of 25,895 participants (62%) on the largest contract

Dentalinsured — LIBERTY DENTAL PLAN OF CALIFORNIA, INC.423 of 25,895 participants (1.6%)

Visiondeclared, not on Schedule A

Lifeinsured — PRUDENTIAL INSURANCE COMPANY OF AMERICA76,631 of 25,895 participants

Disabilitydeclared, not on Schedule A

Dental: LIBERTY DENTAL PLAN OF CALIFORNIA, INC. covers 423 of 25,895 participants (1.6%) on Schedule A.

Also declared: death benefits.

Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.

Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.

Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.

Plan brief

Schedule A lists 3 insured contracts covering health, dental and life; the largest, with KAISER FOUNDATION HEALTH PLAN, INC., covers 16,171 people.

The filing declares health, dental, life, vision and disability. Vision and disability appear with no insured contract on Schedule A. That coverage may be self-funded, or placed with a carrier that is not on this filing.

Reported premium across the insured contracts is $98,273,489, with $1,162 in disclosed broker commissions — about 0% of premium.

The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.

CARL W. ROMSTADT is the broker of record on 1 of the 3 contracts; the rest name a different broker or none.

Schedule A insurance contracts

Carrier	Benefits	Covered	Renews	Premium	Commission
LIBERTY DENTAL PLAN OF CALIFORNIA, INC.	Health, Dental	423	Jan 1, 2025	$58,137	$1,162
KAISER FOUNDATION HEALTH PLAN, INC.	Health	16,171	Jun 1, 2024	$96,200,088	$0
PRUDENTIAL INSURANCE COMPANY OF AMERICA	Life	76,631	Jan 1, 2025	$2,015,264	$0

Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.

See the filing at the Department of Labor

Administrator and service providers

Plan administrator on the filing

UFCW & EMPLOYERS BENEFIT TRUST

EIN 94-6078804

UFCW GROUP ADMINISTRATION LLC

Plan administrator · EIN 26-0048379

$12,201,183

paid directly by the plan

BLUE SHIELD OF CALIFORNIA

Claims processing · EIN 94-0360524

$3,413,861

paid directly by the plan

SOLIDARITUS

Named on Schedule C · EIN 87-3068107

$774,826

paid directly by the plan

DELTA DENTAL

Contract administrator · EIN 94-1461312

$734,416

paid directly by the plan

ELIXIR

Claims processing · EIN 90-1011712

$730,591

paid directly by the plan

MEDEXPERT INTERNATIONAL INC

Contract administrator · EIN 94-3360248

$699,885

paid directly by the plan

EIDE BAILLY LLP

Accounting and audit · EIN 45-0250958

$527,072

paid directly by the plan

HEALTH MANAGEMENT CONCEPTS

Contract administrator · EIN 75-3189468

$523,374

paid directly by the plan

HORIZON ACTUARIAL SERVICES, LLC

Named on Schedule C · EIN 38-3647875

$421,776

paid directly by the plan

SEGAL COMPANY

Named on Schedule C · EIN 94-1503999

$334,072

paid directly by the plan

UFCW LOCAL 5

Contract administrator · EIN 20-8028546

$309,087

paid directly by the plan

VISION SERVICE PLAN

Contract administrator · EIN 23-7316300

$263,587

paid directly by the plan

ULLICO INVESTMENT ADVISORS INC.

Named on Schedule C · EIN 52-6435649

$259,967

paid directly by the plan

PHARMACY BENEFIT SOLUTIONS

Contract administrator · EIN 47-0866096

$257,851

paid directly by the plan

UFCW LOCAL 648

Contract administrator · EIN 94-0525380

$224,411

paid directly by the plan

NEW ENGLAND PENSION CONSULTANTS

Named on Schedule C · EIN 26-1429809

$118,796

paid directly by the plan

JACE MARKETING SOLUTIONS

Contract administrator · EIN 27-2412041

$73,903

paid directly by the plan

PODIATRY PLAN

Contract administrator · EIN 94-2864053

$68,732

paid directly by the plan

UFCW LOCAL 8

Contract administrator · EIN 94-0801845

$59,801

paid directly by the plan

HUDSON EDGE INVESTMENT PARTNERS

Named on Schedule C · EIN 52-1296988

$41,488

paid directly by the plan

CIGNA

Claims processing · EIN 59-1031071

$41,178

paid directly by the plan

NORTHERN TRUST

Custodian · EIN 36-2723087

$31,043

paid directly by the plan

LABCORP

Contract administrator · EIN 83-3697312

$19,175

paid directly by the plan

The plan administrator is from line 3a of the main form. The service providers are named on Schedule C of this filing. We publish company names only.

Money the plan held and paid out

Plan assets at year end

$475,551,394

Paid out in benefits

$438,529,792

Paid to insurance carriersSchedule H, line 2e(2)

$103,393,776

Independent accountantEIN 45-0250958

EIDE BAILLY LLP

Accountant's opinion (Schedule H, line 3a)

Unmodified

Audit fee

$71,800

Sourced from U.S. DOL EFAST2 Form 5500 · Schedule H

These are the plan's own figures from Schedule H, the financial statement it files. They are not the premium on Schedule A.

Other plans filed by this employer

plan 501Insured benefit plan · 4 Schedule A contractsRenews ~Jun 1

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