401k Plan data: CORNERSTONE FITNESS TEXAS LLC HEALTH & WELFARE PLAN plan

CORNERSTONE FITNESS TEXAS LLC HEALTH & WELFARE PLAN 401k Plan overview

Plan Name	CORNERSTONE FITNESS TEXAS LLC HEALTH & WELFARE PLAN
Plan identification number	501

CORNERSTONE FITNESS TEXAS LLC HEALTH & WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

CORNERSTONE FITNESS TEXAS LLC has sponsored the creation of one or more 401k plans.

Company Name: CORNERSTONE FITNESS TEXAS LLC

Employer identification number (EIN): 208495837

NAIC Classification: 713900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CORNERSTONE FITNESS TEXAS LLC HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 MEGAN CASSMAN 2024-08-07

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	MEGAN CASSMAN	2024-08-07

Form 5500 Responses for CORNERSTONE FITNESS TEXAS LLC HEALTH & WELFARE PLAN

2023: CORNERSTONE FITNESS TEXAS LLC HEALTH & WELFARE PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	First time form 5500 has been submitted	Yes
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

927184

Policy instance

Insurance contract or identification number	927184
Number of Individuals Covered	168
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $7,394
Total amount of fees paid to insurance company	USD $1,217
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $73,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

950745

Policy instance

Insurance contract or identification number	950745
Number of Individuals Covered	63
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $4,102
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $23,094
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )

Policy contract number

E5914270

Policy instance

Insurance contract or identification number	E5914270
Number of Individuals Covered	118
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $14,341
Total amount of fees paid to insurance company	USD $8,836
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $36,497
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

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Company Name:	CORNERSTONE FITNESS TEXAS LLC
Employer identification number (EIN):	208495837
NAIC Classification:	713900