Form 5500 · Employee benefit plan · SCOTTSDALE, AZ
BLACK ROCK COFFEE HOLDINGS, LLC
BLACK ROCK COFFEE HOLDINGS, LLC of SCOTTSDALE, AZ files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is USI INSURANCE SERVICES NORTHWEST. Coverage is written through REGENCE BLUECROSS BLUESHIELD OF OREGON and 2 other carriers. The plan's most recent policy period ended in May.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 83-1415331 · plan 501 · as of Jul 2026
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Commission |
|---|---|---|---|---|
| REGENCE BLUECROSS BLUESHIELD OF OREGON | Health, Vision | 288 | May | $56,825 |
| OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | Dental | 302 | May | $6,145 |
| USABLE LIFE | Life, Disability | 544 | May | $4,522 |
Questions
Who is BLACK ROCK COFFEE HOLDINGS, LLC's benefits broker?
Per its most recent Form 5500 Schedule A, BLACK ROCK COFFEE HOLDINGS, LLC's broker of record is USI INSURANCE SERVICES NORTHWEST.
What insurance carrier does BLACK ROCK COFFEE HOLDINGS, LLC use?
BLACK ROCK COFFEE HOLDINGS, LLC's benefit plan is written through REGENCE BLUECROSS BLUESHIELD OF OREGON, among 3 disclosed carriers.
When does BLACK ROCK COFFEE HOLDINGS, LLC's group plan renew?
The most recent Schedule A policy period for BLACK ROCK COFFEE HOLDINGS, LLC ended in May. Group plans typically renew on the same annual cycle.
Where does this data come from?
All figures are drawn from BLACK ROCK COFFEE HOLDINGS, LLC's public Form 5500 filing with the U.S. Department of Labor (EFAST2). Form 5500 is a public record.