Form 5500 · Employee benefit plan · RIVERSIDE, CA
SAFEWAY BUILDING SYSTEMS, INC.
The filing calls this plan SAFEWAY BUILDING SYSTEMS, INC. WELFARE BENEFIT PLAN.
SAFEWAY BUILDING SYSTEMS, INC. of RIVERSIDE, CA insures health, dental, vision, life and disability coverage for its employees, per Schedule A of its Form 5500. Its broker of record is INTELLIBENEFITS INS SERVICES, INC.. Coverage is written through AETNA HEALTH, INC. and 3 other carriers. The plan's most recent policy period ended in June.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 33-0773564 · plan 520 · plan year 2025, filed Feb 12, 2026
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Disability: COLONIAL LIFE & ACCIDENT INSURANCE COMPANY covers 7 of 110 participants (6.4%) on Schedule A.
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 4 insured contracts covering health, dental, vision, life and disability; the largest, with AETNA HEALTH, INC., covers 92 people.
Reported premium across the insured contracts is $500,203, with $25,765 in disclosed broker commissions — about 5.2% of premium.
The most recent policy period ended in June, and the plan year ends June 30. Group contracts typically renew on that annual cycle.
INTELLIBENEFITS INS SERVICES, INC. is the broker of record on 3 of the 4 contracts; the rest name a different broker or none.
4 carriers appear on the filing, including AETNA HEALTH, INC., AETNA LIFE INSURANCE COMPANY, PRINCIPAL LIFE INSURANCE COMPANY and COLONIAL LIFE & ACCIDENT INSURANCE COMPANY. AETNA HEALTH, INC. writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| AETNA HEALTH, INC. | Health | 92 | Jul 1, 2025 | $290,168 | $11,794 |
| PRINCIPAL LIFE INSURANCE COMPANY | Health, Dental, Vision, Life | 172 | Jul 1, 2025 | $65,155 | $7,396 |
| AETNA LIFE INSURANCE COMPANY | Health | 24 | Jul 1, 2025 | $140,788 | $5,720 |
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | Disability | 7 | Jul 1, 2025 | $4,092 | $855 |
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.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Reported to OSHA
Reported to OSHA for 2025: 125 employees, 0 recordable cases, 0 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
How this plan compares
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