Form 5500 · Employee benefit plan · LEHI, UT
SAFE STREETS USA LLC
SAFE STREETS USA LLC's employee benefit plan is documented in its annual Form 5500 filing with the Department of Labor. Its broker of record is BLACK INK INSURANCE INC.. Coverage is written through REGENCE BLUESHIELD OF IDAHO, INC. and 8 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 27-4001370 · plan 501 · as of Aug 2026
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| REGENCE BLUESHIELD OF IDAHO, INC. | Health, Stop-loss | 576 | December | $997,678 | $300,473 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | — | 550 | January | $93,954 | $14,094 |
| USABLE LIFE | Life | 250 | December | $65,571 | $13,379 |
| DELTA DENTAL INSURANCE COMPANY | Dental | 329 | December | $264,819 | $13,223 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Disability | 133 | January | $55,185 | $8,278 |
| VSP VISION CARE | Vision | 236 | December | $41,229 | $4,122 |
| USABLE LIFE | Life | 25 | December | $11,812 | $2,527 |
| USABLE LIFE | Life | 576 | December | $8,136 | $906 |
| UNUM | — | 545 | January | $74,569 | $220 |
Questions
Who is SAFE STREETS USA LLC's benefits broker?
Per its most recent Form 5500 Schedule A, SAFE STREETS USA LLC's broker of record is BLACK INK INSURANCE INC..
What insurance carrier does SAFE STREETS USA LLC use?
SAFE STREETS USA LLC's benefit plan is written through REGENCE BLUESHIELD OF IDAHO, INC., among 9 disclosed carriers.
When does SAFE STREETS USA LLC's group plan renew?
The most recent Schedule A policy period for SAFE STREETS USA LLC ended in December. Group plans typically renew on the same annual cycle.
Where does this data come from?
All figures are drawn from SAFE STREETS USA LLC's public Form 5500 filing with the U.S. Department of Labor (EFAST2). Form 5500 is a public record.