Form 5500 · Employee benefit plan · MONTGOMERY, AL
VISCOFAN USA INC
The filing calls this plan VISCOFAN USA INC-HOURLY EMPLOYEES.
VISCOFAN USA INC of MONTGOMERY, AL insures health, life and disability coverage for its employees, per Schedule A of its Form 5500. Its broker of record is MERCER HEALTH & BENEFITS LLC. Coverage is written through SYMETRA LIFE INSURANCE COMPANY and 2 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 63-1196441 · plan 501 · plan year 2024, filed Jul 25, 2025
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How this plan is funded
Both, as reported
The medical insurance contracts on the filing cover fewer than half the people in the plan, so the rest is paid another way.
A stop-loss policy appears on a Form 5500 only when the plan itself is the beneficiary, or the premiums are paid from plan money. Many employers buy stop-loss and never report it here. So a plan with no stop-loss on its filing may still have it.
Benefits declared on this filing
Health: the largest of the 2 insured health contracts, with TRANSAMERICA INSURANCE CO., covers 11 of 188 participants (5.9%) on Schedule A.
Also declared: death benefits.
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 3 insured contracts covering health, life and disability; the largest, with SYMETRA LIFE INSURANCE COMPANY, covers 156 people.
The filing declares health, life, disability, dental and vision. Dental and vision appear with no insured contract on Schedule A. That coverage may be self-funded, or placed with a carrier that is not on this filing.
Reported premium across the insured contracts is $111,934, with $18,408 in disclosed broker commissions — about 16% 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.
MERCER HEALTH & BENEFITS LLC is the broker of record on 2 of the 3 contracts; the rest name a different broker or none.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| TRANSAMERICA INSURANCE CO. | Health | 11 | Jan 1, 2025 | $49,544 | $8,743 |
| SYMETRA LIFE INSURANCE COMPANY | Life, Disability | 156 | Jan 1, 2025 | $57,436 | $8,615 |
| EXPRESS SCRIPTS, INC. | Health | 5 | Jan 1, 2025 | $4,954 | $1,050 |
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: 605 employees, 25 recordable cases, 34 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
How this plan compares
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