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| Plan Name | CVPH LONG TERM DISABILITY BENEFITS PROGRAM |
| Plan identification number | 508 |
| 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 |
|---|---|---|---|---|---|
| 508 | 2021-01-01 | JUDY PETERSON | 2022-10-14 | MICHELLE LEBEAU | 2022-10-14 |
| 508 | 2021-01-01 | JUDY PETERSON | 2023-07-06 | MICHELLE LEBEAU | 2023-07-06 |
| 508 | 2020-01-01 | ||||
| 508 | 2019-01-01 | ||||
| 508 | 2018-01-01 | ||||
| 508 | 2017-01-01 | MICHELLE LEBEAU | |||
| 508 | 2016-06-01 | STEPHENS MUNDY |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) | |
| Policy contract number | 681721G |
| Policy instance | 1 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) | |
| Policy contract number | 681721G |
| Policy instance | 1 |
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) | |
| Policy contract number | 000000715356 |
| Policy instance | 1 |
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) | |
| Policy contract number | 715356 |
| Policy instance | 1 |
| FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 ) | |
| Policy contract number | 715356 |
| Policy instance | 1 |
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