Form 5500 · Employee benefit plan · SALT LAKE CITY, UT
HEMASOURCE, INC.
HEMASOURCE, INC. of SALT LAKE CITY, UT insures health, dental, vision, life and disability coverage for its employees, per Schedule A of its Form 5500. Its broker of record is USI INSURANCE SERVICES LLC. Coverage is written through REGENCE BLUECROSS BLUESHIELD OF UTAH and 1 other carrier. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 87-0574076 · plan 501 · as of Aug 2026
Plan brief
Schedule A lists 2 insured contracts covering health, dental, vision, life and disability; the largest, with REGENCE BLUECROSS BLUESHIELD OF UTAH, covers 267 people.
Reported premium across the insured contracts is $2,104,918, with $111,174 in disclosed broker commissions — about 5.3% 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.
USI INSURANCE SERVICES LLC is the broker of record on all 2 contracts.
Two carriers split the book: REGENCE BLUECROSS BLUESHIELD OF UTAH and UNITED OF OMAHA LIFE INSURANCE COMPANY.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| REGENCE BLUECROSS BLUESHIELD OF UTAH | Health | 267 | December | $1,883,509 | $94,618 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Dental, Vision, Life, Disability | 138 | December | $221,409 | $16,556 |
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