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CEDAR LAKE LODGE GROUP ACCIDENT CRITICAL ILLNESS LEGAL INSURANCE PLAN 401k Plan overview

Plan NameCEDAR LAKE LODGE GROUP ACCIDENT CRITICAL ILLNESS LEGAL INSURANCE PLAN
Plan identification number 505

CEDAR LAKE LODGE GROUP ACCIDENT CRITICAL ILLNESS LEGAL INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Prepaid legal
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

CEDAR LAKE LODGE, INC. has sponsored the creation of one or more 401k plans.

Company Name:CEDAR LAKE LODGE, INC.
Employer identification number (EIN):610713587
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Additional information about CEDAR LAKE LODGE, INC.

Jurisdiction of Incorporation: New York Department of State
Incorporation Date: 1991-06-25
Company Identification Number: 1557491
Legal Registered Office Address: 43 WAYNE AVENUE
Rockland
STONY POINT
United States of America (USA)
10980

More information about CEDAR LAKE LODGE, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CEDAR LAKE LODGE GROUP ACCIDENT CRITICAL ILLNESS LEGAL INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5052021-09-01MARGARET WAUGH2023-03-22
5052020-09-01MARGARET WAUGH2022-01-19
5052019-09-01MARGARET WAUGH2021-02-03
5052018-09-01MARGARET WAUGH2020-05-18

Plan Statistics for CEDAR LAKE LODGE GROUP ACCIDENT CRITICAL ILLNESS LEGAL INSURANCE PLAN

401k plan membership statisitcs for CEDAR LAKE LODGE GROUP ACCIDENT CRITICAL ILLNESS LEGAL INSURANCE PLAN

Measure Date Value
2021: CEDAR LAKE LODGE GROUP ACCIDENT CRITICAL ILLNESS LEGAL INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year2021-09-01144
Total number of active participants reported on line 7a of the Form 55002021-09-0152
Number of retired or separated participants receiving benefits2021-09-010
Number of other retired or separated participants entitled to future benefits2021-09-010
Total of all active and inactive participants2021-09-0152
Number of employers contributing to the scheme2021-09-010
2020: CEDAR LAKE LODGE GROUP ACCIDENT CRITICAL ILLNESS LEGAL INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year2020-09-01280
Total number of active participants reported on line 7a of the Form 55002020-09-01144
Number of retired or separated participants receiving benefits2020-09-010
Number of other retired or separated participants entitled to future benefits2020-09-010
Total of all active and inactive participants2020-09-01144
Number of employers contributing to the scheme2020-09-010
2019: CEDAR LAKE LODGE GROUP ACCIDENT CRITICAL ILLNESS LEGAL INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year2019-09-01113
Total number of active participants reported on line 7a of the Form 55002019-09-01280
Number of retired or separated participants receiving benefits2019-09-010
Number of other retired or separated participants entitled to future benefits2019-09-010
Total of all active and inactive participants2019-09-01280
Number of employers contributing to the scheme2019-09-010
2018: CEDAR LAKE LODGE GROUP ACCIDENT CRITICAL ILLNESS LEGAL INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year2018-09-01100
Total number of active participants reported on line 7a of the Form 55002018-09-01113
Number of retired or separated participants receiving benefits2018-09-010
Number of other retired or separated participants entitled to future benefits2018-09-010
Total of all active and inactive participants2018-09-01113
Number of employers contributing to the scheme2018-09-010

Form 5500 Responses for CEDAR LAKE LODGE GROUP ACCIDENT CRITICAL ILLNESS LEGAL INSURANCE PLAN

2021: CEDAR LAKE LODGE GROUP ACCIDENT CRITICAL ILLNESS LEGAL INSURANCE PLAN 2021 form 5500 responses
2021-09-01Type of plan entitySingle employer plan
2021-09-01Plan funding arrangement – InsuranceYes
2021-09-01Plan benefit arrangement – InsuranceYes
2020: CEDAR LAKE LODGE GROUP ACCIDENT CRITICAL ILLNESS LEGAL INSURANCE PLAN 2020 form 5500 responses
2020-09-01Type of plan entitySingle employer plan
2020-09-01Plan funding arrangement – InsuranceYes
2020-09-01Plan benefit arrangement – InsuranceYes
2019: CEDAR LAKE LODGE GROUP ACCIDENT CRITICAL ILLNESS LEGAL INSURANCE PLAN 2019 form 5500 responses
2019-09-01Type of plan entitySingle employer plan
2019-09-01Plan funding arrangement – InsuranceYes
2019-09-01Plan benefit arrangement – InsuranceYes
2018: CEDAR LAKE LODGE GROUP ACCIDENT CRITICAL ILLNESS LEGAL INSURANCE PLAN 2018 form 5500 responses
2018-09-01Type of plan entitySingle employer plan
2018-09-01First time form 5500 has been submittedYes
2018-09-01Plan funding arrangement – InsuranceYes
2018-09-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number8210010
Policy instance 1
Insurance contract or identification number8210010
Number of Individuals Covered14
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $334
Total amount of fees paid to insurance companyUSD $161
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $3,444
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $334
Amount paid for insurance broker fees104
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION, SUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number200652
Policy instance 2
Insurance contract or identification number200652
Number of Individuals Covered122
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $5,652
Total amount of fees paid to insurance companyUSD $467
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 providedACCIDENT,CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $29,776
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,652
Amount paid for insurance broker fees467
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION, SUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number8210010
Policy instance 1
Insurance contract or identification number8210010
Number of Individuals Covered12
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $764
Total amount of fees paid to insurance companyUSD $101
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $7,644
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $630
Amount paid for insurance broker fees101
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number200652
Policy instance 2
Insurance contract or identification number200652
Number of Individuals Covered144
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $9,366
Total amount of fees paid to insurance companyUSD $634
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 providedACCIDENT,CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $35,660
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,366
Amount paid for insurance broker fees548
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION NON-MONETARY COMPENSATION
Insurance broker organization code?3
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number8210010
Policy instance 1
Insurance contract or identification number8210010
Number of Individuals Covered32
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $857
Total amount of fees paid to insurance companyUSD $112
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $8,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $798
Amount paid for insurance broker fees112
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number200652
Policy instance 2
Insurance contract or identification number200652
Number of Individuals Covered280
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $7,290
Total amount of fees paid to insurance companyUSD $423
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 providedACCIDENT,CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $44,631
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,004
Amount paid for insurance broker fees158
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number8210010
Policy instance 1
Insurance contract or identification number8210010
Number of Individuals Covered28
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $638
Total amount of fees paid to insurance companyUSD $78
Other welfare benefits providedLEGAL
Welfare Benefit Premiums Paid to CarrierUSD $6,384
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $638
Amount paid for insurance broker fees78
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number200652
Policy instance 2
Insurance contract or identification number200652
Number of Individuals Covered265
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $9,823
Total amount of fees paid to insurance companyUSD $422
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 providedACCIDENT,CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $42,695
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $5,119
Amount paid for insurance broker fees82
Additional information about fees paid to insurance brokerNON-MONETARY G AND E
Insurance broker organization code?3

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