Form 5500 · Employee benefit plan · ALPHARETTA, GA
LX HAUSYS AMERICA, INC.
The filing calls this plan LX HAUSYS AMERICA, INC. BENEFIT PLAN.
LX HAUSYS AMERICA, INC. of ALPHARETTA, GA files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is FALLON BENEFITS GROUP INC.. Coverage is written through CIGNA HEALTH AND LIFE INSURANCE COMPANY and 6 other carriers. The plan's most recent policy period ended in June.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 22-2895551 · plan 504 · plan year 2025, filed Nov 13, 2025
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160 other employer plans in Georgia have policy years ending in June. 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: 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 12 insured contracts covering health, dental, vision, life and disability; the largest, with CIGNA HEALTH AND LIFE INSURANCE COMPANY, covers 1,089 people.
Reported premium across the insured contracts is $6,300,946, with $499,582 in disclosed broker commissions — about 7.9% of premium.
The most recent policy period ended in June, and the plan year ends June 30. Group contracts typically renew on that annual cycle.
FALLON BENEFITS GROUP INC. is the broker of record on 7 of the 12 contracts; the rest name a different broker or none.
7 carriers appear on the filing, including CIGNA HEALTH AND LIFE INSURANCE COMPANY, FOUR EVER LIFE INS CO., LIFE INSURANCE COMPANY OF NORTH AMERICA and KAISER FOUNDATION HEALTH PLAN, INC.. 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 | 1,089 | Jul 1, 2025 | $5,430,702 | $395,996 |
| FOUR EVER LIFE INS CO. | Health | 55 | Jul 1, 2025 | $311,053 | $31,106 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA | Life | 426 | Jul 1, 2025 | $179,663 | $26,950 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA | Disability | 548 | Jul 1, 2025 | $92,745 | $13,912 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA | Disability | 548 | Jul 1, 2025 | $91,140 | $13,671 |
| TRUSTMARK INSURANCE COMPANY | Life | 55 | Jul 1, 2025 | $35,876 | $5,205 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA | — | 139 | Jul 1, 2025 | $29,760 | $4,464 |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | 0 | Jul 1, 2025 | $26,278 | $2,408 |
| EYEMED VISION CARE | Vision | 475 | Jul 1, 2025 | $26,553 | $2,178 |
| KAISER FOUNDATION HEALTH PLAN, INC. | Health | 8 | Jul 1, 2025 | $61,434 | $1,967 |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | 0 | Jul 1, 2025 | $13,874 | $1,538 |
| NEW YORK LIFE GROUP INSURANCE COMPANY OF NEW YORK | Disability | 548 | Jul 1, 2025 | $1,868 | $187 |
Premium and claims on this contract
CIGNA HEALTH AND LIFE INSURANCE COMPANY, contract 3338989. For the contract year on this filing, the carrier reported $5,430,702 in premium earned and $5,922,232 in claims incurred. Dividing one by the other gives 109%.
- CIGNA HEALTH AND LIFE INSURANCE COMPANY, contract 3338989 reported $959,189 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. We publish company names only.
Reported to OSHA
Reported to OSHA for 2025: 356 employees, 9 recordable cases, 183 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
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Renewal calendar
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