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  5. EXCELLUS HEALTH PLAN, INC.

EXCELLUS HEALTH PLAN, INC.

Company Details

Name: EXCELLUS HEALTH PLAN, INC.
Jurisdiction: New York
Legal type: DOMESTIC NOT-FOR-PROFIT CORPORATION
Status: Active
Date of registration: 02 Jan 1936 (89 years ago)
Entity Number: 38007
ZIP code: 14647
County: Monroe
Place of Formation: New York
Address: 165 COURT STREET, ROCHESTER, NY, United States, 14647

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
V23MY7HELMA7 2025-02-26 165 COURT STREET, ROCHESTER, NY, 14647, 0001, USA 165 COURT ST, ROCHESTER, NY, 14647, 0001, USA

Business Information
URL http://www.excellusbcbs.com
Division Name EXCELLUS BLUECROSS BLUESHIELD
Congressional District 25
State/Country of Incorporation NY, USA
Activation Date 2024-02-29
Initial Registration Date 2004-01-14
Entity Start Date 2006-01-01
Fiscal Year End Close Date Dec 31

Service Classifications
NAICS Codes 524114

Points of Contacts
Electronic Business
Title PRIMARY POC
Name KIM GANDY
Role SVP ACCOUNTING & CORPORATE CONTROLLER
Address 165 COURT ST, ROCHESTER, NY, 14647, USA
Title ALTERNATE POC
Name ANNMARIE MESICK
Role CLINICAL ACCREDITATION ADMINISTRATOR
Address 165 COURT ST, ROCHESTER, NY, 14647, USA
Government Business
Title PRIMARY POC
Name DONNA MONROE
Role DIRECTOR SAFETY NET
Address 165 COURT ST, ROCHESTER, NY, 14647, USA
Past Performance
Title ALTERNATE POC
Name ANNMARIE MESICK
Role CLINICAL ADMINISTRATOR
Address 165 COURT ST, ROCHESTER, NY, 14647, USA

Commercial and government entity program

CAGE number Status Type Established CAGE Update Date CAGE Expiration SAM Expiration
3PPP0 Active Non-Manufacturer 2004-01-14 2024-03-11 2029-02-28 2025-02-26

Contact Information
POC DONNA MONROE
Phone +1 585-231-6874
Address 165 COURT STREET, ROCHESTER, NY, 14647 0001, UNITED STATES

Ownership of Offeror Information
Highest Level Owner Information not Available
Immediate Level Owner Information not Available
List of Offerors (0) Information not Available

Legal Entity Identifier

LEI number Registered As Jurisdiction Of Formation General Category Entity Status Entity created at
254900XW4TFFU135LI22 38007 US-NY GENERAL ACTIVE 1936-01-02

Addresses
Legal 165 COURT STREET, ROCHESTER, US-NY, US, 14647
Headquarters 165 COURT STREET, ROCHESTER, US-NY, US, 14647

Registration details
Registration Date 2020-07-07
Last Update 2024-05-17
Status ISSUED
Next Renewal 2025-06-07
LEI Issuer 5493001KJTIIGC8Y1R12
Corroboration Level FULLY_CORROBORATED
Data Validated As 38007

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
EXCELLUS HEALTH AND DENTAL PLAN 2009 150329043 2010-07-30 EXCELLUS HEALTH PLAN, INC. 5165
File View Page
Three-digit plan number (PN) 502
Effective date of plan 1935-12-31
Business code 524140
Sponsor’s telephone number 5854541400
Plan sponsor’s mailing address 165 COURT STREET, ROCHESTER, NY, 14647
Plan sponsor’s address 165 COURT STREET, ROCHESTER, NY, 14647

Plan administrator’s name and address
Administrator’s EIN 150329043
Plan administrator’s name EXCELLUS HEALTH PLAN, INC.
Plan administrator’s address 165 COURT STREET, ROCHESTER, NY, 14647
Administrator’s telephone number 5854541400

Number of participants as of the end of the plan year
Active participants 4489
Retired or separated participants receiving benefits 878

Signature of
Role Plan administrator
Date 2010-07-30
Name of individual signing KENNETH DILLER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-07-30
Name of individual signing PATRICE SCHEG
Valid signature Filed with authorized/valid electronic signature
EXCELLUS GROUP TERM LIFE INSURANCE PLAN 2009 150329043 2010-07-30 EXCELLUS HEALTH PLAN, INC. 5330
File View Page
Three-digit plan number (PN) 507
Effective date of plan 1954-09-01
Business code 524140
Sponsor’s telephone number 5854541400
Plan sponsor’s mailing address 165 COURT STREET, ROCHESTER, NY, 14647
Plan sponsor’s address 165 COURT STREET, ROCHESTER, NY, 14647

Plan administrator’s name and address
Administrator’s EIN 150329043
Plan administrator’s name EXCELLUS HEALTH PLAN, INC.
Plan administrator’s address 165 COURT STREET, ROCHESTER, NY, 14647
Administrator’s telephone number 5854541400

Number of participants as of the end of the plan year
Active participants 3997
Retired or separated participants receiving benefits 821

Signature of
Role Plan administrator
Date 2010-07-30
Name of individual signing KENNETH DILLER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-07-30
Name of individual signing PATRICE SCHEG
Valid signature Filed with authorized/valid electronic signature
EXCELLUS HEALTH PLAN, INC. LONG TERM CARE 2009 150329043 2010-07-30 EXCELLUS HEALTH PLAN, INC. 376
File View Page
Three-digit plan number (PN) 509
Effective date of plan 1988-01-01
Business code 524140
Sponsor’s telephone number 5854541400
Plan sponsor’s mailing address 165 COURT STREET, ROCHESTER, NY, 14647
Plan sponsor’s address 165 COURT STREET, ROCHESTER, NY, 14647

Plan administrator’s name and address
Administrator’s EIN 150329043
Plan administrator’s name EXCELLUS HEALTH PLAN, INC.
Plan administrator’s address 165 COURT STREET, ROCHESTER, NY, 14647
Administrator’s telephone number 5854541400

Number of participants as of the end of the plan year
Active participants 172
Retired or separated participants receiving benefits 52

Signature of
Role Plan administrator
Date 2010-07-29
Name of individual signing KENNETH DILLER
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-07-30
Name of individual signing PATRICE SCHEG
Valid signature Filed with authorized/valid electronic signature
EXCELLUS HEALTH PLAN TRAVEL INSURANCE PROGRAM 2009 150329043 2010-07-30 EXCELLUS HEALTH PLAN, INC. 3850
File View Page
Three-digit plan number (PN) 504
Effective date of plan 1979-01-01
Business code 524140
Sponsor’s telephone number 5854541400
Plan sponsor’s mailing address 165 COURT STREET, ROCHESTER, NY, 14647
Plan sponsor’s address 165 COURT STREET, ROCHESTER, NY, 14647

Plan administrator’s name and address
Administrator’s EIN 150329043
Plan administrator’s name EXCELLUS HEALTH PLAN, INC.
Plan administrator’s address 165 COURT STREET, ROCHESTER, NY, 14647
Administrator’s telephone number 5854541400

Number of participants as of the end of the plan year
Active participants 3901

Signature of
Role Plan administrator
Date 2010-07-30
Name of individual signing PATRICE SCHEG
Valid signature Filed with authorized/valid electronic signature

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent 165 COURT STREET, ROCHESTER, NY, United States, 14647

History

Start date End date Type Value
1998-12-16 1999-08-10 Address GATEWAY CENTRE, 150 EAST MAIN STREET, ROCHESTER, NY, 14642, USA (Type of address: Service of Process)
1996-01-11 1998-12-16 Address 344 SOUTH WARREN STREET, SYRACUSE, NY, 13202, USA (Type of address: Service of Process)
1984-12-04 1996-01-11 Address 344 SOUTH WARREN ST, SYRACUSE, NY, 13202, USA (Type of address: Service of Process)
1984-12-04 1996-01-11 Name BLUE CROSS AND BLUE SHIELD OF CENTRAL NEW YORK, INC.
1973-08-15 1984-12-04 Address 407 S. STATE ST., SYRACUSE, NY, 13201, USA (Type of address: Service of Process)
1970-01-02 1984-12-04 Name BLUE CROSS OF CENTRAL NEW YORK, INC.
1937-06-21 1970-01-02 Name GROUP HOSPITAL SERVICE, INC.
1936-01-02 1937-06-21 Name SYRACUSE HOSPITAL SERVICE CORPORATION

Filings

Filing Number Date Filed Type Effective Date
011001000185 2001-10-01 CERTIFICATE OF MERGER 2001-10-01
010102000253 2001-01-02 CERTIFICATE OF MERGER 2001-01-02
990810000129 1999-08-10 CERTIFICATE OF CHANGE 1999-08-10
981231000247 1998-12-31 CERTIFICATE OF AMENDMENT 1998-12-31
981216000682 1998-12-16 CERTIFICATE OF MERGER 1998-12-31
960111000506 1996-01-11 CERTIFICATE OF AMENDMENT 1996-01-11
B180302-5 1985-01-08 CERTIFICATE OF AMENDMENT 1985-01-08
B168295-14 1984-12-04 CERTIFICATE OF MERGER 1985-01-01
Z003989-2 1979-05-11 ASSUMED NAME CORP INITIAL FILING 1979-05-11
A92672-2 1973-08-15 CERTIFICATE OF AMENDMENT 1973-08-15

USAspending Awards. Contracts

Contract Type Award or IDV Flag PIID Start Date Current End Date Potential End Date
DCA AWARD DTSL5504CC0633 2008-01-01 2008-12-31 2008-12-31
Unique Award Key CONT_AWD_DTSL5504CC0633_6947_-NONE-_-NONE-
Awarding Agency Department of Transportation
Link View Page

Description
Title ADMINISTER DENTAL PLAN
NAICS Code 524114: DIRECT HEALTH AND MEDICAL INSURANCE CARRIERS
Product and Service Codes R499: OTHER PROFESSIONAL SERVICES

Recipient Details
Recipient EXCELLUS HEALTH PLAN INC.
UEI V23MY7HELMA7
Legacy DUNS 066802257
Recipient Address UNITED STATES, 344 SOUTH WARREN ST., SYRACUSE, 132022008
DCA AWARD DTSL5510CC0234 2010-01-01 2010-12-31 2014-12-31
Unique Award Key CONT_AWD_DTSL5510CC0234_6947_-NONE-_-NONE-
Awarding Agency Department of Transportation
Link View Page

Description
Title DESIGN, FURNISH, AND ADMINISTER A DENTAL INSURANCE PLAN FOR APPROXIMATELY EIGHTY CORPORATION EMPLOYEES FOR A ONE YEAR PERIOD BEGINNING 01/01/2010.
NAICS Code 524114: DIRECT HEALTH AND MEDICAL INSURANCE CARRIERS
Product and Service Codes G008: OTHER GOVERNMENT INSURANCE PROGRAMS

Recipient Details
Recipient EXCELLUS HEALTH PLAN INC.
UEI V23MY7HELMA7
Legacy DUNS 066802257
Recipient Address UNITED STATES, 165 COURT ST, ROCHESTER, 146470001

Motor Carrier Census

USDOT Number Carrier Operation MCS-150 Form Date MCS-150 Mileage MCS-150 Year Power Units Drivers Operation Classification
1518873 Intrastate Non-Hazmat 2006-06-21 - - 1 4 Private(Property)
Legal Name EXCELLUS HEALTH PLAN INC
DBA Name -
Physical Address 165 COURT ST, ROCHESTER, NY, 14647, US
Mailing Address 165 COURT ST, ROCHESTER, NY, 14647, US
Phone (585) 238-4336
Fax (585) 238-4400
E-mail -

Safety Measurement System - All Transportation
Total Number of Inspections for the measurement period (24 months) 0
Driver Fitness BASIC Serious Violation Indicator No
Vehicle Maintenance BASIC Acute/Critical Indicator No
Unsafe Driving BASIC Acute/Critical Indicator No
Driver Fitness BASIC Roadside Performance measure value 0
Hours-of-Service (HOS) Compliance BASIC Roadside Performance measure value 0
Total Number of Driver Inspections for the measurment period 0
Vehicle Maintenance BASIC Roadside Performance measure value 0
Total Number of Vehicle Inspections for the measurement period 0
Controlled Substances and Alcohol BASIC Roadside Performance measure value 0
Unsafe Driving BASIC Roadside Performance Measure Value 0
Number of inspections with at least one Driver Fitness BASIC violation 0
Number of inspections with at least one Hours-of-Service BASIC violation 0
Total Number of Driver Inspections containing at least one Driver Out-of-Service Violation 0
Number of inspections with at least one Vehicle Maintenance BASIC violation 0
Total Number of Vehicle Inspections containing at least one Vehicle Out-of-Service violation 0
Number of inspections with at least one Controlled Substances and Alcohol BASIC violation 0
Number of inspections with at least one Unsafe Driving BASIC violation 0

Related by officers

THE CORPORATION

ARSHIA DESIGNS INC. AAA VACUUM CORP. ATLANTICA TELECOM, INC. MISTY SPORTSWEAR, INC. FAT JAMS ELECTRONICS INC. CROQUEMBOUCHE, INC. LONG BEACH PEDIATRIC GROUP, P.C. LAW OFFICES OF JOSEPH A. GRECO, P.C. TEREZ, INC. 732 CINNAMON BEACH INC.

Related by address

165 COURT STREET, ROCHESTER, NY, United States, 14647

EXCELLUS HEALTH PLAN COMMUNITY CARE, LLC EXCELLUS VENTURES, INC. LIFETIME BENEFIT SOLUTIONS, INC. LIFETIME WORKFORCE SOLUTIONS, LLC MEDAMERICA, INC. TELAMON LLC NORTH STAR HOME HEALTH MANAGEMENT, INC. EBS-RMSCO INSURANCE AGENCY, INC. 344 SOUTH WARREN STREET CORPORATION

Date of last update: 19 Mar 2025

Sources: New York Secretary of State

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