Form 5500 · Employee benefit plan · ALPHARETTA, GA
CHEMENCE INC
The filing calls this plan CHEMENCE INC WELFARE BENEFIT PLAN.
CHEMENCE INC of ALPHARETTA, GA spreads its employee benefits across 3 insurance carriers, according to its Form 5500 Schedule A. Its broker of record is MCGRIFF SEIBELS AND WILLIAMS INC. Coverage is written through CIGNA HEALTH AND 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 34-1607498 · plan 501 · plan year 2025, filed Dec 15, 2025
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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
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 6 insured contracts covering health, dental, vision, life and disability; the largest, with CIGNA HEALTH AND LIFE INSURANCE COMPANY, covers 191 people.
Reported premium across the insured contracts is $1,463,437, with $20,598 in disclosed broker commissions — about 1.4% of premium.
The health contract's policy period ended in December, while at least one ancillary line's policy period ended in February. The plan is on a split renewal cycle.
MCGRIFF SEIBELS AND WILLIAMS INC is the broker of record on 5 of the 6 contracts; the rest name a different broker or none.
3 carriers appear on the filing, including CIGNA HEALTH AND LIFE INSURANCE COMPANY, LIFE INSURANCE COMPANY OF NORTH AMERICA and EYEMED VISION CARE. CIGNA HEALTH AND LIFE INSURANCE COMPANY writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY | Health, Dental | 191 | Jan 1, 2025 | $1,371,084 | $7,232 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA | Disability | 185 | Mar 1, 2025 | $39,517 | $5,928 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA | Life | 185 | Mar 1, 2025 | $23,122 | $3,468 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA | Disability | 31 | Mar 1, 2025 | $16,692 | $2,504 |
| EYEMED VISION CARE | Vision | 174 | Mar 1, 2025 | $10,008 | $1,014 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA | — | 370 | Mar 1, 2025 | $3,014 | $452 |
Premium and claims on this contract
CIGNA HEALTH AND LIFE INSURANCE COMPANY, contract 00625426. For the contract year on this filing, the carrier reported $1,371,084 in premium earned and $1,661,987 in claims incurred. Dividing one by the other gives 121%.
- CIGNA HEALTH AND LIFE INSURANCE COMPANY, contract 00625426 reported $52,086 in retention.
Retention is what the carrier kept of the premium after claims, as reported: administration, commissions and other charges.
Only experience-rated contracts report these figures, so most filings leave them blank.
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. The service providers are named on Schedule C of this filing. We publish company names only.
Other plans filed by this employer
How this plan compares
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