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| Plan Name | HEALTH & WELFARE BENEFITS PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | EMPIRE PORTFOLIO GROUP PAYROLL LLC |
| Employer identification number (EIN): | 862011795 |
| NAIC Classification: | 713900 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2023-04-01 | JESSICA KUMARI | 2024-10-22 | ||
| 501 | 2022-04-01 | JESSICA KUMARI | 2023-12-06 |
| 2023: HEALTH & WELFARE BENEFITS PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-04-01 | Type of plan entity | Single employer plan |
| 2023-04-01 | Plan funding arrangement – Insurance | Yes |
| 2023-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2022: HEALTH & WELFARE BENEFITS PLAN 2022 form 5500 responses | ||
| 2022-04-01 | Type of plan entity | Single employer plan |
| 2022-04-01 | First time form 5500 has been submitted | Yes |
| 2022-04-01 | Plan funding arrangement – Insurance | Yes |
| 2022-04-01 | Plan benefit arrangement – Insurance | Yes |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |||||||||||||||||||||
| Policy contract number | 635924 | ||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||
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| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |||||||||||||||||||||
| Policy contract number | 635924 | ||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||
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| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |||||||||||||||||||||
| Policy contract number | 635924 | ||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |||||||||||||||||||||
| Policy contract number | 635924 | ||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||
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