# HEALTH & WELFARE BENEFITS PLAN

Health and welfare plan sponsored by **EMPIRE PORTFOLIO GROUP PAYROLL LLC** (dba ORANGETHEORY FITNESS). Form 5500 filing for plan year 2025.

| Field | Value |
|---|---|
| Sponsor | EMPIRE PORTFOLIO GROUP PAYROLL LLC |
| EIN | 862011795 |
| Plan number | 501 |
| Plan year | 2025 |
| Location | NEW YORK, NY |
| Industry | health, wellness and fitness |
| Funding | fully insured |
| Total premiums | $770K |
| Participants | 111 |
| Persons covered | 120 |

## Insurance carriers (Schedule A)

| Carrier | Coverage |
|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY | Health, Rx, Dental, Vision, Indemnity |

## Brokers

| Broker | Placed with |
|---|---|
| WORLD INSURANCE ASSOCIATES LLC | CIGNA HEALTH AND LIFE INSURANCE COMPANY |
| FNA INSURANCE SERVICES INC | CIGNA HEALTH AND LIFE INSURANCE COMPANY |
| WORLD INSURANCE ASSOCIATES LLC | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES |
| FNA INSURANCE SERVICES INC | 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/862011795-501
- Cite as: PlanOptica, https://planoptica.com/welfare/862011795-501
- More: https://planoptica.com/llms.txt · API waitlist: https://planoptica.com/developers