# CITYBLOCK HEALTH, INC. EMPLOYEE HEALTH AND WELFARE BENEFITS PLAN

Health and welfare plan sponsored by **CITYBLOCK HEALTH, INC.**. Form 5500 filing for plan year 2025.

| Field | Value |
|---|---|
| Sponsor | CITYBLOCK HEALTH, INC. |
| EIN | 822839581 |
| Plan number | 501 |
| Plan year | 2025 |
| Location | BROOKLYN, NY |
| Industry | hospital & health care |
| Funding | fully insured |
| Total premiums | $20.3M |
| Participants | 1,009 |
| Persons covered | 1,218 |

## Insurance carriers (Schedule A)

| Carrier | Coverage |
|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY | Health, Rx, PPO, Dental, Vision, Indemnity |
| UNUM LIFE INSURANCE COMPANY OF AMERICA | Life, STD, LTD, Other |

## Brokers

| Broker | Placed with |
|---|---|
| SEQUOIA BENEFITS & INS SVCS LLC | CIGNA HEALTH AND LIFE INSURANCE COMPANY |
| MERCER HEALTH AND BENEFITS, LLC | CIGNA HEALTH AND LIFE INSURANCE COMPANY |
| SEQUOIA BENEFITS & INS SVCS LLC | FIRST UNUM LIFE INSURANCE COMPANY |
| MERCER HEALTH AND BENEFITS, LLC | FIRST UNUM LIFE INSURANCE COMPANY |
| SEQUOIA BENEFITS & INS SVCS LLC | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES |
| MERCER HEALTH AND BENEFITS, LLC | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES |

## About this data

- Source: public Form 5500 filings from the U.S. Department of Labor (EBSA), rebuilt on each DOL release.
- Full page (charts, history, peer benchmarks, fees, contacts): https://planoptica.com/welfare/822839581-501
- Cite as: PlanOptica, https://planoptica.com/welfare/822839581-501
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