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| Plan Name | VISION INSURANCE PLAN |
| Plan identification number | 507 |
| 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 |
|---|---|---|---|---|---|
| 507 | 2021-01-01 | JUDY PETERSON | 2022-10-14 | MICHELLE LEBEAU | 2022-10-14 |
| 507 | 2021-01-01 | JUDY PETERSON | 2023-07-06 | MICHELLE LEBEAU | 2023-07-06 |
| 507 | 2020-01-01 | ||||
| 507 | 2019-01-01 | ||||
| 507 | 2018-01-01 | ||||
| 507 | 2017-01-01 | MICHELLE LEBEAU | |||
| 507 | 2016-01-01 | STEPHENS MUNDY | |||
| 507 | 2015-01-01 | STEPHENS MUNDY | |||
| 507 | 2014-01-01 | STEPHENS MUNDY |
| Measure | Date | Value |
|---|---|---|
| 2021: VISION INSURANCE PLAN 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-01-01 | 2,025 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 1,779 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 58 |
| Total of all active and inactive participants | 2021-01-01 | 1,837 |
| 2020: VISION INSURANCE PLAN 2020 401k membership | ||
| Total participants, beginning-of-year | 2020-01-01 | 1,009 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 1,967 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 58 |
| Total of all active and inactive participants | 2020-01-01 | 2,025 |
| Total participants | 2020-01-01 | 2,025 |
| 2019: VISION INSURANCE PLAN 2019 401k membership | ||
| Total participants, beginning-of-year | 2019-01-01 | 963 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 985 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 24 |
| Total of all active and inactive participants | 2019-01-01 | 1,009 |
| Total participants | 2019-01-01 | 1,009 |
| 2018: VISION INSURANCE PLAN 2018 401k membership | ||
| Total participants, beginning-of-year | 2018-01-01 | 1,139 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 963 |
| Total of all active and inactive participants | 2018-01-01 | 963 |
| Total participants | 2018-01-01 | 963 |
| 2017: VISION INSURANCE PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-01-01 | 1,087 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 1,139 |
| Total of all active and inactive participants | 2017-01-01 | 1,139 |
| Total participants | 2017-01-01 | 1,139 |
| 2016: VISION INSURANCE PLAN 2016 401k membership | ||
| Total participants, beginning-of-year | 2016-01-01 | 1,108 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 1,087 |
| Total of all active and inactive participants | 2016-01-01 | 1,087 |
| Total participants | 2016-01-01 | 1,087 |
| 2015: VISION INSURANCE PLAN 2015 401k membership | ||
| Total participants, beginning-of-year | 2015-01-01 | 851 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 1,037 |
| Total of all active and inactive participants | 2015-01-01 | 1,037 |
| Total participants | 2015-01-01 | 1,037 |
| 2014: VISION INSURANCE PLAN 2014 401k membership | ||
| Total participants, beginning-of-year | 2014-01-01 | 821 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 851 |
| Total of all active and inactive participants | 2014-01-01 | 851 |
| Total participants | 2014-01-01 | 851 |
| 2021: VISION 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: VISION 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: VISION 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: VISION 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: VISION 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: VISION 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: VISION 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: VISION INSURANCE PLAN 2014 form 5500 responses | ||
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | First time form 5500 has been submitted | Yes |
| 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 |
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) | |
| Policy contract number | 720762 |
| Policy instance | 1 |
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) | |
| Policy contract number | 720762 |
| Policy instance | 1 |
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) | |
| Policy contract number | 720762 |
| Policy instance | 1 |
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) | |
| Policy contract number | 720762 |
| Policy instance | 1 |
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) | |
| Policy contract number | 720762 |
| Policy instance | 1 |
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) | |
| Policy contract number | 720762 |
| Policy instance | 1 |
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) | |
| Policy contract number | 720762 |
| Policy instance | 1 |