Form 5500 · Employee benefit plan · ALPHARETTA, GA
EXCALIBUR HOMES, LLC
The filing calls this plan EXCALIBUR HOMES, LLC WELLFARE BENEFIT PLAN.
Public Form 5500 records show how EXCALIBUR HOMES, LLC of ALPHARETTA, GA, a real estate employer, structures its employee benefits. Its broker of record is KAYDA INSURANCE SERVICES. Coverage is written through HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC. and 1 other carrier. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 58-2251822 · plan 501 · plan year 2023, filed Jun 5, 2024
Get an email when this employer files a new Form 5500, and again about four months before its plan renews.
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.
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 and life; the largest, with HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC., covers 88 people.
Reported premium across the insured contracts is $1,231,455, with $31,465 in disclosed broker commissions — about 2.6% 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.
KAYDA INSURANCE SERVICES is the broker of record on all 2 contracts.
Two carriers split the book: HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC. and HUMANA INSURANCE COMPANY.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC. | Health | 88 | Jan 1, 2024 | $1,142,405 | $26,818 |
| HUMANA INSURANCE COMPANY | Dental, Vision, Life | 134 | Jan 1, 2024 | $89,050 | $4,647 |
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
Subscribers see how this compares with similar plans in Georgia. A subscription also adds this plan's filing history and the renewal calendar for its state. See plans and prices
Without an account you can open 10 employer, broker and carrier pages a day, including through an AI assistant, and 50 a day with a free account. Paid plans are what keep these records free to read.
More employer plans in Georgia — largest plans, brokers, carriers and renewal months.