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ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 401k Plan overview

Plan NameALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY
Plan identification number 511

ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

CROUSE HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name:CROUSE HOSPITAL
Employer identification number (EIN):160960470
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5112018-01-01
5112017-01-01JOHN BERGEMANN
5112016-01-01JOHN BERGEMANN
5112015-01-01JOHN BERGEMANN
5112014-01-01JOHN BERGEMANN
5112013-01-01JOHN BERGEMANN
5112012-01-01JOHN BERGEMANN
5112011-01-01JOHN BERGEMANN
5112010-01-01JOHN BERGEMANN
5112009-01-01JOHN BERGEMANN

Plan Statistics for ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY

401k plan membership statisitcs for ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY

Measure Date Value
2018: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2018 401k membership
Total participants, beginning-of-year2018-01-01567
Total number of active participants reported on line 7a of the Form 55002018-01-010
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-010
2017: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2017 401k membership
Total participants, beginning-of-year2017-01-01590
Total number of active participants reported on line 7a of the Form 55002017-01-01567
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01567
2016: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2016 401k membership
Total participants, beginning-of-year2016-01-01630
Total number of active participants reported on line 7a of the Form 55002016-01-01590
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01590
2015: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2015 401k membership
Total participants, beginning-of-year2015-01-01596
Total number of active participants reported on line 7a of the Form 55002015-01-01629
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 participants2015-01-01629
2014: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2014 401k membership
Total participants, beginning-of-year2014-01-01559
Total number of active participants reported on line 7a of the Form 55002014-01-01580
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01580
2013: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2013 401k membership
Total participants, beginning-of-year2013-01-01599
Total number of active participants reported on line 7a of the Form 55002013-01-01559
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-01559
2012: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2012 401k membership
Total participants, beginning-of-year2012-01-01591
Total number of active participants reported on line 7a of the Form 55002012-01-01599
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01599
2011: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2011 401k membership
Total participants, beginning-of-year2011-01-01570
Total number of active participants reported on line 7a of the Form 55002011-01-01591
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01591
2010: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2010 401k membership
Total participants, beginning-of-year2010-01-01757
Total number of active participants reported on line 7a of the Form 55002010-01-01781
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-01781
2009: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2009 401k membership
Total participants, beginning-of-year2009-01-01569
Total number of active participants reported on line 7a of the Form 55002009-01-01558
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01558

Form 5500 Responses for ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY

2018: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingYes
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 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 filingNo
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: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 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: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 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: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 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: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 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: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 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
2010: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 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

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number52765
Policy instance 1
Insurance contract or identification number52765
Number of Individuals Covered0
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $60,195
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedBASIC AND OPTIONAL AD&D, OPTIONAL/DEPENDENT LIFE
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 $163,066
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,004
Insurance broker organization code?3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number52765
Policy instance 1
Insurance contract or identification number52765
Number of Individuals Covered567
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,502
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedBASIC AND OPTIONAL AD&D, OPTIONAL/DEPENDENT LIFE
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 $150,181
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,502
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerNONE
Insurance broker organization code?3
Insurance broker nameFIRST NIAGARA RISK MANAGEMENT INC

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