Form 5500 · Employee benefit plan · IRVING, TX
VICEROY HOTEL MANAGEMENT LLC
The filing calls this plan VICEROY HOTEL GROUP WELFARE BENEFITS PLAN.
VICEROY HOTEL MANAGEMENT LLC of IRVING, TX insures health, dental, vision, life and disability coverage for its employees, per Schedule A of its Form 5500. Its broker of record is MERCER HEALTH AND BENEFITS, LLC. Coverage is written through BLUE CROSS OF CALIFORNIA and 7 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 33-1076496 · plan 501 · plan year 2024, filed Oct 13, 2025
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4,208 other employer plans in Texas have policy years ending in December. See the full list on the renewal calendar, or ask for it in Claude or ChatGPT.
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: prepaid legal, 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.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
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 9 insured contracts covering health, dental, vision, life and disability; the largest, with BLUE CROSS OF CALIFORNIA, covers 296 people.
Reported premium across the insured contracts is $3,083,897, with $137,017 in disclosed broker commissions — about 4.4% of premium.
The health contract's policy period ended in December, while at least one ancillary line's policy period ended in March. The plan is on a split renewal cycle.
MERCER HEALTH AND BENEFITS, LLC is the broker of record on 6 of the 9 contracts; the rest name a different broker or none.
8 carriers appear on the filing, including BLUE CROSS OF CALIFORNIA, KAISER FOUNDATION HEALTH PLAN, INC., UNUM LIFE INSURANCE COMPANY OF AMERICA and KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC.. BLUE CROSS OF CALIFORNIA writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUE CROSS OF CALIFORNIA | Health, Dental, Vision | 296 | Jan 1, 2025 | $2,050,635 | $81,781 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA | Life, Disability | 289 | Jan 1, 2025 | $231,103 | $21,519 |
| KAISER FOUNDATION HEALTH PLAN, INC. | Health | 50 | Jan 1, 2025 | $520,985 | $15,421 |
| KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC. | Health | 28 | Jan 1, 2025 | $184,634 | $7,683 |
| AETNA LIFE INSURANCE COMPANY | Health | 7 | Jan 1, 2025 | $68,172 | $6,906 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA | Life | 51 | Jan 1, 2025 | $18,594 | $1,859 |
| ZURICH AMERICAN INSURANCE COMPANY | — | 282 | Apr 1, 2024 | $4,351 | $1,305 |
| METLIFE LEGAL PLANS | — | 20 | Sep 1, 2024 | $3,758 | $376 |
| METROPOLITAN GENERAL INSURANCE COMPANY | — | 19 | Jan 1, 2025 | $1,665 | $167 |
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.
Reported to OSHA
Reported to OSHA for 2025: 18 employees, 0 recordable cases, 0 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
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