Form 5500 · Employee benefit plan · COSTA MESA, CA
STACKS BOWER NUMISMATICS LLC
The filing calls this plan STACK'S BOWER NUMISMATICS LLC WELFARE BENEFIT PLAN.
STACKS BOWER NUMISMATICS LLC of COSTA MESA, CA files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is ACRISURE WEST INSURANCE SERVICES,. Coverage is written through BLUE SHIELD OF CALIFORNIA and 2 other carriers. The plan's most recent policy period ended in May.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 27-4383642 · plan 501 · plan year 2025, filed Dec 29, 2025
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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: other welfare.
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 10 insured contracts covering health, dental, vision, life and disability; the largest, with BLUE SHIELD OF CALIFORNIA, covers 237 people.
Reported premium across the insured contracts is $1,779,750, with $17,308 in disclosed broker commissions — about 1% of premium.
The most recent policy period ended in May, and the plan year ends May 31. Group contracts typically renew on that annual cycle.
ACRISURE WEST INSURANCE SERVICES, is the broker of record on 8 of the 10 contracts; the rest name a different broker or none.
3 carriers appear on the filing, including BLUE SHIELD OF CALIFORNIA, UNITED OF OMAHA LIFE INSURANCE COMPANY and THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA. BLUE SHIELD OF CALIFORNIA writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Dental | 98 | Jun 1, 2025 | $92,694 | $6,489 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | — | 42 | Jun 1, 2025 | $11,228 | $2,245 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Disability | 153 | Jun 1, 2025 | $26,743 | $1,872 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | — | 55 | Jun 1, 2025 | $16,126 | $1,612 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life | 153 | Jun 1, 2025 | $20,593 | $1,442 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Vision | 140 | Jun 1, 2025 | $19,382 | $1,356 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | — | 56 | Jun 1, 2025 | $9,557 | $955 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life | 77 | Jun 1, 2025 | $12,730 | $891 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | Dental | 42 | Jun 1, 2025 | $4,463 | $446 |
| BLUE SHIELD OF CALIFORNIA | Health | 237 | Jun 1, 2025 | $1,566,234 | $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.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
How this plan compares
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