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LIFEPLAN CCO NY, LLC HEALTH AND WELFARE BENEFIT PL 401k Plan overview

Plan NameLIFEPLAN CCO NY, LLC HEALTH AND WELFARE BENEFIT PL
Plan identification number 501

LIFEPLAN CCO NY, LLC HEALTH AND WELFARE BENEFIT PL Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

LIFEPLAN CCO NY, LLC has sponsored the creation of one or more 401k plans.

Company Name:LIFEPLAN CCO NY, LLC
Employer identification number (EIN):823070045
NAIC Classification:624100
NAIC Description: Individual and Family Services

Additional information about LIFEPLAN CCO NY, LLC

Jurisdiction of Incorporation: New York Department of State
Incorporation Date: 2017-07-10
Company Identification Number: 5167043
Legal Registered Office Address: 1020 MARY STREET
Oneida
UTICA
United States of America (USA)
13501

More information about LIFEPLAN CCO NY, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LIFEPLAN CCO NY, LLC HEALTH AND WELFARE BENEFIT PL

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-07-01
5012021-07-01
5012020-07-01DEAN JOHNSTON2022-04-15 DEAN JOHNSTON2022-04-15
5012019-07-01DEAN JOHNSTON2021-04-09 DEAN JOHNSTON2021-04-09
5012018-07-01DEAN JOHNSTON2020-07-13 DEAN JOHNSTON2020-07-13

Plan Statistics for LIFEPLAN CCO NY, LLC HEALTH AND WELFARE BENEFIT PL

401k plan membership statisitcs for LIFEPLAN CCO NY, LLC HEALTH AND WELFARE BENEFIT PL

Measure Date Value
2022: LIFEPLAN CCO NY, LLC HEALTH AND WELFARE BENEFIT PL 2022 401k membership
Total participants, beginning-of-year2022-07-01804
Total number of active participants reported on line 7a of the Form 55002022-07-01843
Total of all active and inactive participants2022-07-01843
Total participants2022-07-01843
2021: LIFEPLAN CCO NY, LLC HEALTH AND WELFARE BENEFIT PL 2021 401k membership
Total participants, beginning-of-year2021-07-01791
Total number of active participants reported on line 7a of the Form 55002021-07-01802
Total of all active and inactive participants2021-07-01802
Total participants2021-07-01802
2020: LIFEPLAN CCO NY, LLC HEALTH AND WELFARE BENEFIT PL 2020 401k membership
Total participants, beginning-of-year2020-07-01821
Total number of active participants reported on line 7a of the Form 55002020-07-01787
Total of all active and inactive participants2020-07-01787
2019: LIFEPLAN CCO NY, LLC HEALTH AND WELFARE BENEFIT PL 2019 401k membership
Total participants, beginning-of-year2019-07-01431
Total number of active participants reported on line 7a of the Form 55002019-07-01821
Total of all active and inactive participants2019-07-01821
2018: LIFEPLAN CCO NY, LLC HEALTH AND WELFARE BENEFIT PL 2018 401k membership
Total participants, beginning-of-year2018-07-010
Total number of active participants reported on line 7a of the Form 55002018-07-01431
Total of all active and inactive participants2018-07-01431

Form 5500 Responses for LIFEPLAN CCO NY, LLC HEALTH AND WELFARE BENEFIT PL

2022: LIFEPLAN CCO NY, LLC HEALTH AND WELFARE BENEFIT PL 2022 form 5500 responses
2022-07-01Type of plan entitySingle employer plan
2022-07-01Submission has been amendedNo
2022-07-01This submission is the final filingNo
2022-07-01This return/report is a short plan year return/report (less than 12 months)No
2022-07-01Plan is a collectively bargained planNo
2022-07-01Plan funding arrangement – InsuranceYes
2022-07-01Plan funding arrangement – General assets of the sponsorYes
2022-07-01Plan benefit arrangement – InsuranceYes
2022-07-01Plan benefit arrangement – General assets of the sponsorYes
2021: LIFEPLAN CCO NY, LLC HEALTH AND WELFARE BENEFIT PL 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Submission has been amendedNo
2021-07-01This submission is the final filingNo
2021-07-01This return/report is a short plan year return/report (less than 12 months)No
2021-07-01Plan is a collectively bargained planNo
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – InsuranceYes
2020: LIFEPLAN CCO NY, LLC HEALTH AND WELFARE BENEFIT PL 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – InsuranceYes
2019: LIFEPLAN CCO NY, LLC HEALTH AND WELFARE BENEFIT PL 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – InsuranceYes
2018: LIFEPLAN CCO NY, LLC HEALTH AND WELFARE BENEFIT PL 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01First time form 5500 has been submittedYes
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00550444
Policy instance 1
Insurance contract or identification number00550444
Number of Individuals Covered844
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
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 BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENT, AD&D, HOSPITAL INDEMNITY, SPECIFIED DISEASE
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 $928,059
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00550444
Policy instance 1
Insurance contract or identification number00550444
Number of Individuals Covered815
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $36,166
Total amount of fees paid to insurance companyUSD $5,060
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 BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 $904,389
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,281
Insurance broker organization code?3
Amount paid for insurance broker fees5060
EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )
Policy contract number00122999
Policy instance 2
Insurance contract or identification number00122999
Number of Individuals Covered542
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $147,479
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 BenefitYes
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
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $50,975
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00550444
Policy instance 1
Insurance contract or identification number00550444
Number of Individuals Covered787
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $31,027
Total amount of fees paid to insurance companyUSD $13,860
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $768,577
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,027
Amount paid for insurance broker fees13860
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )
Policy contract number00122999
Policy instance 2
Insurance contract or identification number00122999
Number of Individuals Covered577
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $136,632
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $136,632
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00550444
Policy instance 1
Insurance contract or identification number00550444
Number of Individuals Covered821
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $36,462
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $732,409
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $36,462
Insurance broker organization code?3
EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )
Policy contract number00122999
Policy instance 2
Insurance contract or identification number00122999
Number of Individuals Covered519
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $120,148
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $120,148
Amount paid for insurance broker fees0
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00550444
Policy instance 1
Insurance contract or identification number00550444
Number of Individuals Covered431
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $27,605
Total amount of fees paid to insurance companyUSD $4,818
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $398,446
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,121
Amount paid for insurance broker fees4818
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )
Policy contract number00122999
Policy instance 2
Insurance contract or identification number00122999
Number of Individuals Covered182
Insurance policy start date2018-05-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $47,496
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $47,496
Insurance broker organization code?3

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