401k Plan data: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN plan

ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 401k Plan overview

Plan Name	ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN
Plan identification number	503

ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Long-term disability cover

401k Sponsoring company profile

ESSEX COUNTY CHAPTER NYSARC, INC. has sponsored the creation of one or more 401k plans.

Company Name: ESSEX COUNTY CHAPTER NYSARC, INC.

Employer identification number (EIN): 141563885

NAIC Classification: 623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2022-01-01
503 2021-01-01
503 2020-01-01
503 2019-01-01
503 2018-01-01 MARTIN NEPHEW NATHAN RICKERT 2019-05-30
503 2017-10-01
503 2016-10-01 MARTIN NEPHEW ROBIN PIERCE 2018-03-29
503 2015-10-01 MARTIN NEPHEW ROBIN PIERCE 2017-05-25
503 2014-10-01 MARTIN NEPHEW ROBIN PIERCE 2016-04-25
503 2013-10-01 MARTIN NEPHEW ROBIN PIERCE 2015-04-27
503 2011-10-01 MARTIN NEPHEW ROBIN PIERCE 2013-04-24
503 2010-10-01 MARTIN NEPHEW ROBIN PIERCE 2012-04-23
503 2009-10-01 MARTIN NEPHEW ROBIN PIERCE 2011-04-28

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
503	2022-01-01
503	2021-01-01
503	2020-01-01
503	2019-01-01
503	2018-01-01	MARTIN NEPHEW	NATHAN RICKERT	2019-05-30
503	2017-10-01
503	2016-10-01	MARTIN NEPHEW	ROBIN PIERCE	2018-03-29
503	2015-10-01	MARTIN NEPHEW	ROBIN PIERCE	2017-05-25
503	2014-10-01	MARTIN NEPHEW	ROBIN PIERCE	2016-04-25
503	2013-10-01	MARTIN NEPHEW	ROBIN PIERCE	2015-04-27
503	2011-10-01	MARTIN NEPHEW	ROBIN PIERCE	2013-04-24
503	2010-10-01	MARTIN NEPHEW	ROBIN PIERCE	2012-04-23
503	2009-10-01	MARTIN NEPHEW	ROBIN PIERCE	2011-04-28

Plan Statistics for ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN

401k plan membership statisitcs for ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN

Measure Date Value
2022: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 338
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 361
Total of all active and inactive participants 2022-01-01 361
2021: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 385
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 338
Total of all active and inactive participants 2021-01-01 338
2020: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 402
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 385
Total of all active and inactive participants 2020-01-01 385
Total participants 2020-01-01 385
2019: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 433
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 402
Total of all active and inactive participants 2019-01-01 402
Total participants 2019-01-01 402
2018: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 488
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 433
Total of all active and inactive participants 2018-01-01 433
Total participants 2018-01-01 433
2017: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2017 401k membership
Total participants, beginning-of-year 2017-10-01 497
Total number of active participants reported on line 7a of the Form 5500 2017-10-01 488
Total of all active and inactive participants 2017-10-01 488
Total participants 2017-10-01 488
2016: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year 2016-10-01 496
Total number of active participants reported on line 7a of the Form 5500 2016-10-01 497
Total of all active and inactive participants 2016-10-01 497
Total participants 2016-10-01 497
2015: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year 2015-10-01 491
Total number of active participants reported on line 7a of the Form 5500 2015-10-01 496
Total of all active and inactive participants 2015-10-01 496
Total participants 2015-10-01 0
2014: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year 2014-10-01 541
Total number of active participants reported on line 7a of the Form 5500 2014-10-01 491
Total of all active and inactive participants 2014-10-01 491
Total participants 2014-10-01 0
2013: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year 2013-10-01 541
Total number of active participants reported on line 7a of the Form 5500 2013-10-01 541
Total of all active and inactive participants 2013-10-01 541
Total participants 2013-10-01 0
2011: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year 2011-10-01 488
Total number of active participants reported on line 7a of the Form 5500 2011-10-01 532
Total of all active and inactive participants 2011-10-01 532
Total participants 2011-10-01 532
2010: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2010 401k membership
Total participants, beginning-of-year 2010-10-01 465
Total number of active participants reported on line 7a of the Form 5500 2010-10-01 488
Total of all active and inactive participants 2010-10-01 488
Total participants 2010-10-01 488
2009: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year 2009-10-01 467
Total number of active participants reported on line 7a of the Form 5500 2009-10-01 465
Total of all active and inactive participants 2009-10-01 465
Total participants 2009-10-01 465

Measure	Date	Value
2022: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	338
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	361
Total of all active and inactive participants	2022-01-01	361
2021: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	385
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	338
Total of all active and inactive participants	2021-01-01	338
2020: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	402
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	385
Total of all active and inactive participants	2020-01-01	385
Total participants	2020-01-01	385
2019: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	433
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	402
Total of all active and inactive participants	2019-01-01	402
Total participants	2019-01-01	402
2018: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	488
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	433
Total of all active and inactive participants	2018-01-01	433
Total participants	2018-01-01	433
2017: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2017 401k membership
Total participants, beginning-of-year	2017-10-01	497
Total number of active participants reported on line 7a of the Form 5500	2017-10-01	488
Total of all active and inactive participants	2017-10-01	488
Total participants	2017-10-01	488
2016: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year	2016-10-01	496
Total number of active participants reported on line 7a of the Form 5500	2016-10-01	497
Total of all active and inactive participants	2016-10-01	497
Total participants	2016-10-01	497
2015: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year	2015-10-01	491
Total number of active participants reported on line 7a of the Form 5500	2015-10-01	496
Total of all active and inactive participants	2015-10-01	496
Total participants	2015-10-01	0
2014: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year	2014-10-01	541
Total number of active participants reported on line 7a of the Form 5500	2014-10-01	491
Total of all active and inactive participants	2014-10-01	491
Total participants	2014-10-01	0
2013: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year	2013-10-01	541
Total number of active participants reported on line 7a of the Form 5500	2013-10-01	541
Total of all active and inactive participants	2013-10-01	541
Total participants	2013-10-01	0
2011: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year	2011-10-01	488
Total number of active participants reported on line 7a of the Form 5500	2011-10-01	532
Total of all active and inactive participants	2011-10-01	532
Total participants	2011-10-01	532
2010: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2010 401k membership
Total participants, beginning-of-year	2010-10-01	465
Total number of active participants reported on line 7a of the Form 5500	2010-10-01	488
Total of all active and inactive participants	2010-10-01	488
Total participants	2010-10-01	488
2009: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year	2009-10-01	467
Total number of active participants reported on line 7a of the Form 5500	2009-10-01	465
Total of all active and inactive participants	2009-10-01	465
Total participants	2009-10-01	465

Form 5500 Responses for ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN

2022: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2017 form 5500 responses
2017-10-01	Type of plan entity	Single employer plan
2017-10-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2017-10-01	Plan funding arrangement – Insurance	Yes
2017-10-01	Plan benefit arrangement – Insurance	Yes
2016: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2016 form 5500 responses
2016-10-01	Type of plan entity	Single employer plan
2016-10-01	Plan funding arrangement – Insurance	Yes
2016-10-01	Plan benefit arrangement – Insurance	Yes
2015: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2015 form 5500 responses
2015-10-01	Type of plan entity	Single employer plan
2015-10-01	Plan funding arrangement – Insurance	Yes
2015-10-01	Plan benefit arrangement – Insurance	Yes
2014: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2014 form 5500 responses
2014-10-01	Type of plan entity	Single employer plan
2014-10-01	Plan funding arrangement – Insurance	Yes
2014-10-01	Plan benefit arrangement – Insurance	Yes
2013: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2013 form 5500 responses
2013-10-01	Type of plan entity	Single employer plan
2013-10-01	Plan funding arrangement – Insurance	Yes
2013-10-01	Plan benefit arrangement – Insurance	Yes
2011: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2011 form 5500 responses
2011-10-01	Type of plan entity	Single employer plan
2011-10-01	Plan funding arrangement – Insurance	Yes
2011-10-01	Plan benefit arrangement – Insurance	Yes
2010: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2010 form 5500 responses
2010-10-01	Type of plan entity	Single employer plan
2010-10-01	Plan funding arrangement – Insurance	Yes
2010-10-01	Plan benefit arrangement – Insurance	Yes
2009: ESSEX COUNTY CHAPTER NYSARC INC DBA MOUNTAIN LAKE SERVICES LONG-TERM DISABILITY PLAN 2009 form 5500 responses
2009-10-01	Type of plan entity	Single employer plan
2009-10-01	Plan funding arrangement – Insurance	Yes
2009-10-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

G000B9S8

Policy instance

Insurance contract or identification number	G000B9S8
Number of Individuals Covered	361
Insurance policy start date	2022-01-01
Insurance policy end date	2023-01-01
Total amount of commissions paid to insurance broker	USD $4,459
Total amount of fees paid to insurance company	USD $4,980
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,184
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,459
Amount paid for insurance broker fees	3320
Additional information about fees paid to insurance broker	OTHER SERVICE FEES
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

G000B9S8

Policy instance

Insurance contract or identification number	G000B9S8
Number of Individuals Covered	338
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $4,422
Total amount of fees paid to insurance company	USD $2,811
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,438
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,422
Amount paid for insurance broker fees	1514
Additional information about fees paid to insurance broker	OTHER SERVICE FEES
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

G000B9S8

Policy instance

Insurance contract or identification number	G000B9S8
Number of Individuals Covered	385
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $4,327
Total amount of fees paid to insurance company	USD $3,533
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $46,532
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,327
Amount paid for insurance broker fees	2120
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

G000B9S8

Policy instance

Insurance contract or identification number	G000B9S8
Number of Individuals Covered	402
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $4,347
Total amount of fees paid to insurance company	USD $1,919
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $46,941
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,347
Amount paid for insurance broker fees	1919
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

G000B9S8

Policy instance

Insurance contract or identification number	G000B9S8
Number of Individuals Covered	433
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $4,504
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,419
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,504
Insurance broker organization code?	3

FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )

Policy contract number

226286

Policy instance

Insurance contract or identification number	226286
Insurance policy start date	2017-10-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,418
Total amount of fees paid to insurance company	USD $167
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,362
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	ESSEX COUNTY CHAPTER NYSARC, INC.
Employer identification number (EIN):	141563885
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities