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EXCELLUS HEALTH PLAN LONG TERM CARE INSURANCE 401k Plan overview

Plan NameEXCELLUS HEALTH PLAN LONG TERM CARE INSURANCE
Plan identification number 509

EXCELLUS HEALTH PLAN LONG TERM CARE INSURANCE Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Other welfare benefit cover

401k Sponsoring company profile

EXCELLUS HEALTH PLAN INC. has sponsored the creation of one or more 401k plans.

Company Name:EXCELLUS HEALTH PLAN INC.
Employer identification number (EIN):150329043
NAIC Classification:524140

Additional information about EXCELLUS HEALTH PLAN INC.

Jurisdiction of Incorporation: New York Department of State
Incorporation Date: 1936-01-02
Company Identification Number: 38007
Legal Registered Office Address: 165 COURT STREET
Monroe
ROCHESTER
United States of America (USA)
14647

More information about EXCELLUS HEALTH PLAN INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EXCELLUS HEALTH PLAN LONG TERM CARE INSURANCE

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5092016-01-01KENNETH DILLER RICHARD NANGREAVE2017-07-28
5092015-01-01KENNETH DILLER CAMILLE REAK2016-07-21
5092014-01-01KENNETH DILLER CAMILLE REAK2015-07-30
5092013-01-01KENNETH DILLER CAMILLE REAK2014-07-29
5092012-01-01KENNETH DILLER CAMILLE REAK2013-07-29
5092011-01-01KENNETH DILLER CAMILLE REAK2012-07-20
5092009-01-01KENNETH DILLER PATRICE SCHEG2010-07-30

Plan Statistics for EXCELLUS HEALTH PLAN LONG TERM CARE INSURANCE

401k plan membership statisitcs for EXCELLUS HEALTH PLAN LONG TERM CARE INSURANCE

Measure Date Value
2016: EXCELLUS HEALTH PLAN LONG TERM CARE INSURANCE 2016 401k membership
Total participants, beginning-of-year2016-01-01431
Total number of active participants reported on line 7a of the Form 55002016-01-010
Total of all active and inactive participants2016-01-010
Total participants2016-01-010
2015: EXCELLUS HEALTH PLAN LONG TERM CARE INSURANCE 2015 401k membership
Total participants, beginning-of-year2015-01-01450
Total number of active participants reported on line 7a of the Form 55002015-01-01431
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01431
Total participants2015-01-01431
2014: EXCELLUS HEALTH PLAN LONG TERM CARE INSURANCE 2014 401k membership
Total participants, beginning-of-year2014-01-01430
Total number of active participants reported on line 7a of the Form 55002014-01-01445
Number of retired or separated participants receiving benefits2014-01-015
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01450
Total participants2014-01-01450
2013: EXCELLUS HEALTH PLAN LONG TERM CARE INSURANCE 2013 401k membership
Total participants, beginning-of-year2013-01-01399
Total number of active participants reported on line 7a of the Form 55002013-01-01408
Number of retired or separated participants receiving benefits2013-01-0122
Total of all active and inactive participants2013-01-01430
Total participants2013-01-01430
2012: EXCELLUS HEALTH PLAN LONG TERM CARE INSURANCE 2012 401k membership
Total participants, beginning-of-year2012-01-01343
Total number of active participants reported on line 7a of the Form 55002012-01-01369
Number of retired or separated participants receiving benefits2012-01-0130
Total of all active and inactive participants2012-01-01399
Total participants2012-01-01399
2011: EXCELLUS HEALTH PLAN LONG TERM CARE INSURANCE 2011 401k membership
Total participants, beginning-of-year2011-01-01275
Total number of active participants reported on line 7a of the Form 55002011-01-01300
Number of retired or separated participants receiving benefits2011-01-0143
Total of all active and inactive participants2011-01-01343
Total participants2011-01-01343
2009: EXCELLUS HEALTH PLAN LONG TERM CARE INSURANCE 2009 401k membership
Total participants, beginning-of-year2009-01-01376
Total number of active participants reported on line 7a of the Form 55002009-01-01172
Number of retired or separated participants receiving benefits2009-01-0152
Total of all active and inactive participants2009-01-01224
Total participants2009-01-01224

Form 5500 Responses for EXCELLUS HEALTH PLAN LONG TERM CARE INSURANCE

2016: EXCELLUS HEALTH PLAN LONG TERM CARE INSURANCE 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingYes
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: EXCELLUS HEALTH PLAN LONG TERM CARE INSURANCE 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: EXCELLUS HEALTH PLAN LONG TERM CARE INSURANCE 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: EXCELLUS HEALTH PLAN LONG TERM CARE INSURANCE 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: EXCELLUS HEALTH PLAN LONG TERM CARE INSURANCE 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: EXCELLUS HEALTH PLAN LONG TERM CARE INSURANCE 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: EXCELLUS HEALTH PLAN LONG TERM CARE INSURANCE 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MED AMERICA INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 83438 )
Policy contract number21-702
Policy instance 1
Insurance contract or identification number21-702
Number of Individuals Covered431
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedLONG TERM CARE INSURANCE
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $572,455
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MED AMERICA INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 83438 )
Policy contract number21-702
Policy instance 1
Insurance contract or identification number21-702
Number of Individuals Covered450
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedLONG TERM CARE INSURANCE
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $580,743
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MED AMERICA INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 83438 )
Policy contract number21-702
Policy instance 1
Insurance contract or identification number21-702
Number of Individuals Covered430
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedLONG TERM CARE INSURANCE
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $563,311
MED AMERICA INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 83438 )
Policy contract number21-702
Policy instance 1
Insurance contract or identification number21-702
Number of Individuals Covered399
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLONG TERM CARE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $523,865
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MED AMERICA INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 83438 )
Policy contract number21-702
Policy instance 1
Insurance contract or identification number21-702
Number of Individuals Covered343
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLONG TERM CARE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $460,420
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MED AMERICA INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 83438 )
Policy contract number21-702
Policy instance 1
Insurance contract or identification number21-702
Number of Individuals Covered275
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLONG TERM CARE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $367,796
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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