Form 5500 · Employee benefit plan · PEACHTREE CITY, GA
RINNAI AMERICA
The filing calls this plan RINNAI AMERICA EMPLOYEE BENEFITS PLAN.
Public Form 5500 records show how RINNAI AMERICA of PEACHTREE CITY, GA, a manufacturing employer, structures its employee benefits. Its broker of record is USI INSURANCE SERVICES LLC. Coverage is written through PRUDENTIAL INSURANCE COMPANY OF AMERICA and 3 other carriers. The plan's most recent policy period ended in March.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 95-2915596 · plan 503 · plan year 2025, filed Oct 7, 2025
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101 other employer plans in Georgia have policy years ending in March. See the full list on the renewal calendar, or ask for it in Claude or ChatGPT.
How this plan is funded
Self-funded as reported
The filing names a third-party administrator on Schedule A and reports no medical premium.
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
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.
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 4 insured contracts covering health, dental, vision, life and disability; the largest, with PRUDENTIAL INSURANCE COMPANY OF AMERICA, covers 555 people.
Reported premium across the insured contracts is $1,127,644, with $94,973 in disclosed broker commissions — about 8.4% of premium.
The most recent policy period ended in March, and the plan year ends March 31. Group contracts typically renew on that annual cycle.
USI INSURANCE SERVICES LLC is the broker of record on 2 of the 4 contracts; the rest name a different broker or none.
4 carriers appear on the filing, including PRUDENTIAL INSURANCE COMPANY OF AMERICA, BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA, INC., EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. and U.S. LEGAL SERVICES OF GEORGIA, INC.. PRUDENTIAL INSURANCE COMPANY OF AMERICA writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| PRUDENTIAL INSURANCE COMPANY OF AMERICA | Health, Life, Disability | 555 | Apr 1, 2025 | $633,988 | $93,551 |
| U.S. LEGAL SERVICES OF GEORGIA, INC. | — | 90 | Apr 1, 2025 | $10,012 | $1,422 |
| BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA, INC. | Dental | 1,142 | Apr 1, 2025 | $412,294 | $0 |
| EYEMED VISION CARE ON BEHALF OF FIDELITY SECURITY LIFE INSURANCE CO. | Vision | 1,067 | Apr 1, 2025 | $71,350 | $0 |
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: 639 employees, 7 recordable cases, 542 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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Renewal calendar
101 other employer plans in Georgia are April 1 renewals (policy year ends March).
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