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| Plan Name | LIFE INSURANCE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | CHAMPLAIN VALLEY PHYSICIANS HOSPITAL |
| Employer identification number (EIN): | 141338471 |
| NAIC Classification: | 622000 |
| NAIC Description: | Hospitals |
Additional information about CHAMPLAIN VALLEY PHYSICIANS HOSPITAL
| Jurisdiction of Incorporation: | New York Department of State |
| Incorporation Date: | 1910-10-13 |
| Company Identification Number: | 29737 |
| Legal Registered Office Address: |
75 BEEKMAN STREET Clinton PLATTSBURGH United States of America (USA) 12901 |
More information about CHAMPLAIN VALLEY PHYSICIANS HOSPITAL
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2021-01-01 | JUDY PETERSON | 2022-10-14 | MICHELLE LEBEAU | 2022-10-14 |
| 501 | 2021-01-01 | JUDY PETERSON | 2023-07-06 | MICHELLE LEBEAU | 2023-07-06 |
| 501 | 2020-01-01 | ||||
| 501 | 2019-01-01 | ||||
| 501 | 2018-01-01 | ||||
| 501 | 2018-01-01 | ||||
| 501 | 2017-01-01 | MICHELLE LEBEAU | |||
| 501 | 2016-01-01 | STEPHENS MUNDY | |||
| 501 | 2015-01-01 | STEPHENS MUNDY | |||
| 501 | 2014-01-01 | STEPHENS MUNDY | |||
| 501 | 2013-01-01 | STEPHENS MUNDY | |||
| 501 | 2012-01-01 | STEPHENS MUNDY | |||
| 501 | 2011-01-01 | STEPHENS MUNDY | |||
| 501 | 2010-01-01 | STEPHENS MUNDY | |||
| 501 | 2009-01-01 | STEPHENS MUNDY |
| Measure | Date | Value |
|---|---|---|
| 2021: LIFE INSURANCE PLAN 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-01-01 | 2,526 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 1,885 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 473 |
| Total of all active and inactive participants | 2021-01-01 | 2,358 |
| 2020: LIFE INSURANCE PLAN 2020 401k membership | ||
| Total participants, beginning-of-year | 2020-01-01 | 2,585 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 2,053 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 473 |
| Total of all active and inactive participants | 2020-01-01 | 2,526 |
| Total participants | 2020-01-01 | 2,526 |
| 2019: LIFE INSURANCE PLAN 2019 401k membership | ||
| Total participants, beginning-of-year | 2019-01-01 | 2,552 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 2,130 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 455 |
| Total of all active and inactive participants | 2019-01-01 | 2,585 |
| Total participants | 2019-01-01 | 2,585 |
| 2018: LIFE INSURANCE PLAN 2018 401k membership | ||
| Total participants, beginning-of-year | 2018-01-01 | 2,532 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 2,552 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 433 |
| Total of all active and inactive participants | 2018-01-01 | 2,985 |
| Total participants | 2018-01-01 | 2,985 |
| 2017: LIFE INSURANCE PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-01-01 | 2,603 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 2,104 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 428 |
| Total of all active and inactive participants | 2017-01-01 | 2,532 |
| Total participants | 2017-01-01 | 2,532 |
| 2016: LIFE INSURANCE PLAN 2016 401k membership | ||
| Total participants, beginning-of-year | 2016-01-01 | 2,562 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 2,195 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 407 |
| Total of all active and inactive participants | 2016-01-01 | 2,602 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2016-01-01 | 1 |
| Total participants | 2016-01-01 | 2,603 |
| Number of employers contributing to the scheme | 2016-01-01 | 2,603 |
| 2015: LIFE INSURANCE PLAN 2015 401k membership | ||
| Total participants, beginning-of-year | 2015-01-01 | 2,311 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 2,150 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 385 |
| Total of all active and inactive participants | 2015-01-01 | 2,535 |
| Total participants | 2015-01-01 | 2,535 |
| 2014: LIFE INSURANCE PLAN 2014 401k membership | ||
| Total participants, beginning-of-year | 2014-01-01 | 2,294 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 1,948 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 363 |
| Total of all active and inactive participants | 2014-01-01 | 2,311 |
| Total participants | 2014-01-01 | 2,311 |
| 2013: LIFE INSURANCE PLAN 2013 401k membership | ||
| Total participants, beginning-of-year | 2013-01-01 | 2,294 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 1,948 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 346 |
| Total of all active and inactive participants | 2013-01-01 | 2,294 |
| Total participants | 2013-01-01 | 2,294 |
| 2012: LIFE INSURANCE PLAN 2012 401k membership | ||
| Total participants, beginning-of-year | 2012-01-01 | 2,322 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 2,019 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 326 |
| Total of all active and inactive participants | 2012-01-01 | 2,345 |
| Total participants | 2012-01-01 | 2,345 |
| 2011: LIFE INSURANCE PLAN 2011 401k membership | ||
| Total participants, beginning-of-year | 2011-01-01 | 2,260 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 2,009 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 313 |
| Total of all active and inactive participants | 2011-01-01 | 2,322 |
| Total participants | 2011-01-01 | 2,322 |
| 2010: LIFE INSURANCE PLAN 2010 401k membership | ||
| Total participants, beginning-of-year | 2010-01-01 | 2,174 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 1,956 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 304 |
| Number of other retired or separated participants entitled to future benefits | 2010-01-01 | 0 |
| Total of all active and inactive participants | 2010-01-01 | 2,260 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2010-01-01 | 0 |
| Total participants | 2010-01-01 | 2,260 |
| 2009: LIFE INSURANCE PLAN 2009 401k membership | ||
| Total participants, beginning-of-year | 2009-01-01 | 2,081 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 1,874 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 300 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
| Total of all active and inactive participants | 2009-01-01 | 2,174 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-01-01 | 0 |
| Total participants | 2009-01-01 | 2,174 |
| 2021: LIFE INSURANCE PLAN 2021 form 5500 responses | ||
|---|---|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Submission has been amended | Yes |
| 2021-01-01 | This submission is the final filing | Yes |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: LIFE INSURANCE PLAN 2020 form 5500 responses | ||
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: LIFE INSURANCE PLAN 2019 form 5500 responses | ||
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: LIFE INSURANCE PLAN 2018 form 5500 responses | ||
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: LIFE INSURANCE PLAN 2017 form 5500 responses | ||
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: LIFE INSURANCE PLAN 2016 form 5500 responses | ||
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: LIFE INSURANCE PLAN 2015 form 5500 responses | ||
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: LIFE INSURANCE PLAN 2014 form 5500 responses | ||
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: LIFE INSURANCE PLAN 2013 form 5500 responses | ||
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: LIFE INSURANCE PLAN 2012 form 5500 responses | ||
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: LIFE INSURANCE PLAN 2011 form 5500 responses | ||
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | No |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: LIFE INSURANCE PLAN 2010 form 5500 responses | ||
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Submission has been amended | No |
| 2010-01-01 | This submission is the final filing | No |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-01-01 | Plan is a collectively bargained plan | No |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: LIFE INSURANCE PLAN 2009 form 5500 responses | ||
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0228567 |
| Policy instance | 1 |
| THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 89009 ) | |
| Policy contract number | 755551 |
| Policy instance | 1 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0228567 |
| Policy instance | 2 |
| THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 89009 ) | |
| Policy contract number | 755551 |
| Policy instance | 1 |
| THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 89009 ) | |
| Policy contract number | 755551 |
| Policy instance | 1 |
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) | |
| Policy contract number | SA388003641101 |
| Policy instance | 1 |
| THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 89009 ) | |
| Policy contract number | 755551 |
| Policy instance | 2 |