Form 5500 · Employee benefit plan · SEDALIA, MO
SIERRA BULLETS LLC
The filing calls this plan SIERRA BULLETS LLC HEALTH PLAN.
SIERRA BULLETS LLC of SEDALIA, MO spreads its employee benefits across 4 insurance carriers, according to its Form 5500 Schedule A. Its broker of record is ROBERT E. MILLER INSURANCE AGENCY. Coverage is written through BLUE CROSS BLUE SHIELD OF KANSAS CITY and 3 other carriers. The plan's most recent policy period ended in August.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 95-4170056 · plan 501 · plan year 2025, filed Mar 16, 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
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 7 insured contracts covering health, dental, vision, life and disability; the largest, with BLUE CROSS BLUE SHIELD OF KANSAS CITY, covers 225 people.
Reported premium across the insured contracts is $2,243,502, with $103,912 in disclosed broker commissions — about 4.6% of premium.
The most recent policy period ended in August, and the plan year ends August 31. Group contracts typically renew on that annual cycle.
ROBERT E. MILLER INSURANCE AGENCY is the broker of record on all 7 contracts.
4 carriers appear on the filing, including BLUE CROSS BLUE SHIELD OF KANSAS CITY, STANDARD INSURANCE COMPANY, DELTA DENTAL OF MISSOURI and ADVANTICA INSURANCE COMPANY. BLUE CROSS BLUE SHIELD OF KANSAS CITY writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF KANSAS CITY | Health | 225 | Sep 1, 2025 | $2,056,792 | $82,306 |
| STANDARD INSURANCE COMPANY | Life | 139 | Sep 1, 2025 | $70,305 | $7,084 |
| STANDARD INSURANCE COMPANY | Disability | 88 | Sep 1, 2025 | $42,449 | $6,367 |
| DELTA DENTAL OF MISSOURI | Dental | 203 | Sep 1, 2025 | $52,490 | $4,834 |
| STANDARD INSURANCE COMPANY | Health | 47 | Sep 1, 2025 | $8,085 | $1,983 |
| ADVANTICA INSURANCE COMPANY | Vision | 192 | Sep 1, 2025 | $9,164 | $916 |
| STANDARD INSURANCE COMPANY | Disability | 25 | Sep 1, 2025 | $4,217 | $422 |
Premium and claims on these contracts
STANDARD INSURANCE COMPANY, contract 169276. For the contract year on this filing, the carrier reported $70,305 in premium earned and $504 in claims incurred. Dividing one by the other gives 1%.
STANDARD INSURANCE COMPANY, contract 169276. For the contract year on this filing, the carrier reported $42,449 in premium earned and $3,236 in claims incurred. Dividing one by the other gives 8%.
STANDARD INSURANCE COMPANY, contract 169276. For the contract year on this filing, the carrier reported $4,217 in premium earned and $138 in claims incurred. Dividing one by the other gives 3%.
- STANDARD INSURANCE COMPANY, contract 169276 reported $69,802 in retention.
- STANDARD INSURANCE COMPANY, contract 169276 reported $39,213 in retention.
- STANDARD INSURANCE COMPANY, contract 169276 reported $4,080 in retention.
Retention is what the carrier kept of the premium after claims, as reported: administration, commissions and other charges.
Only experience-rated contracts report these figures, so most filings leave them blank.
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: 132 employees, 3 recordable cases, 0 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
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