Form 5500 · Employee benefit plan · BELLEVUE, WA
OMNIVA LLC
OMNIVA LLC of BELLEVUE, WA files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is SEQUOIA BENEFITS & INS SERVICES LLC. Coverage is written through PREMERA BLUE CROSS and 2 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 87-4310146 · plan 501 · as of Aug 2026
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| PREMERA BLUE CROSS | Health | 648 | December | $6,207,608 | $310,380 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | Dental, Vision, Life, Disability | 297 | December | $605,821 | $81,066 |
| DELTA DENTAL OF WASHINGTON | Dental | 528 | December | $505,942 | $50,594 |
Questions
Who is OMNIVA LLC's benefits broker?
Per its most recent Form 5500 Schedule A, OMNIVA LLC's broker of record is SEQUOIA BENEFITS & INS SERVICES LLC.
What insurance carrier does OMNIVA LLC use?
OMNIVA LLC's benefit plan is written through PREMERA BLUE CROSS, among 3 disclosed carriers.
When does OMNIVA LLC's group plan renew?
The most recent Schedule A policy period for OMNIVA LLC ended in December. Group plans typically renew on the same annual cycle.
Where does this data come from?
All figures are drawn from OMNIVA LLC's public Form 5500 filing with the U.S. Department of Labor (EFAST2). Form 5500 is a public record.