Form 5500 · Employee benefit plan · TYSON, VA
MEMORYBLUE, LLC
The filing calls this plan MEMORYBLUE WELFARE BENEFIT PLAN.
MEMORYBLUE, LLC of TYSON, VA is a 138-participant professional services employer whose group benefits are disclosed in its annual Form 5500 filing. Its broker of record is AON RISK SERVICES INC. OF FLORIDA. Coverage is written through UNITEDHEALTHCARE INSURANCE COMPANY and 1 other carrier. The plan's most recent policy period ended in July.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 04-3632311 · plan 501 · plan year 2025, filed May 15, 2026
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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: death benefits, 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.
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 2 insured contracts covering health, dental, vision, life and disability; the largest, with UNITEDHEALTHCARE INSURANCE COMPANY, covers 133 people.
Reported premium across the insured contracts is $543,567, with $60,259 in disclosed broker commissions — about 11% of premium.
The most recent policy period ended in July, and the plan year ends July 31. Group contracts typically renew on that annual cycle.
AON RISK SERVICES INC. OF FLORIDA is the broker of record on 1 of the 2 contracts; the rest name a different broker or none.
Two carriers split the book: UNITEDHEALTHCARE INSURANCE COMPANY and COLONIAL LIFE & ACCIDENT INSURANCE COMPANY.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| UNITEDHEALTHCARE INSURANCE COMPANY | Health, Dental, Vision | 133 | Aug 1, 2025 | $524,003 | $51,570 |
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | Life, Disability | 22 | Aug 1, 2025 | $19,564 | $8,689 |
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.
Other plans filed by this employer
How this plan compares
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