GRANICUS, LLC SHORT TERM DISABILITY INSURANCE PLAN
|
2022
|
411941088
|
2023-07-25
|
GRANICUS, LLC
|
703
|
|
File |
View Page
|
Three-digit plan number (PN) |
505
|
Effective date of plan |
2017-04-01
|
Business code |
541512
|
Sponsor’s telephone number |
6514008759
|
Plan sponsor’s mailing address |
408 SAINT PETER ST STE 600, SAINT PAUL, MN, 551021122
|
Plan sponsor’s
address |
408 SAINT PETER ST STE 600, SAINT PAUL, MN, 551021122
|
Number of participants as of the end of the plan year
Active participants |
959 |
Retired or separated participants receiving
benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2023-07-25 |
Name of individual signing |
JENNALEE POULSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GRANICUS, LLC VISION INSURANCE PLAN
|
2022
|
411941088
|
2023-07-25
|
GRANICUS, LLC
|
476
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
2017-04-01
|
Business code |
541512
|
Sponsor’s telephone number |
6514008759
|
Plan sponsor’s mailing address |
408 SAINT PETER ST STE 600, SAINT PAUL, MN, 551021122
|
Plan sponsor’s
address |
408 SAINT PETER ST STE 600, SAINT PAUL, MN, 551021122
|
Number of participants as of the end of the plan year
Active participants |
558 |
Retired or separated participants receiving
benefits |
1 |
Signature of
Role |
Plan administrator |
Date |
2023-07-25 |
Name of individual signing |
JENNALEE POULSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GRANICUS, LLC DENTAL INSURANCE PLAN
|
2022
|
411941088
|
2023-07-25
|
GRANICUS, LLC
|
619
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2017-04-01
|
Business code |
541512
|
Sponsor’s telephone number |
6514008759
|
Plan sponsor’s mailing address |
408 SAINT PETER ST STE 600, SAINT PAUL, MN, 551021122
|
Plan sponsor’s
address |
408 SAINT PETER ST STE 600, SAINT PAUL, MN, 551021122
|
Number of participants as of the end of the plan year
Active participants |
721 |
Retired or separated participants receiving
benefits |
3 |
Signature of
Role |
Plan administrator |
Date |
2023-07-25 |
Name of individual signing |
JENNALEE POULSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GRANICUS, LLC LONG TERM DISABILITY INSURANCE PLAN
|
2022
|
411941088
|
2023-07-25
|
GRANICUS, LLC
|
703
|
|
File |
View Page
|
Three-digit plan number (PN) |
506
|
Effective date of plan |
2017-04-01
|
Business code |
541512
|
Sponsor’s telephone number |
6514008759
|
Plan sponsor’s mailing address |
408 SAINT PETER ST STE 600, SAINT PAUL, MN, 551021122
|
Plan sponsor’s
address |
408 SAINT PETER ST STE 600, SAINT PAUL, MN, 551021122
|
Number of participants as of the end of the plan year
Active participants |
959 |
Retired or separated participants receiving
benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2023-07-25 |
Name of individual signing |
JENNALEE POULSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GRANICUS, LLC LIFE INSURANCE PLAN
|
2022
|
411941088
|
2023-07-25
|
GRANICUS, LLC
|
703
|
|
File |
View Page
|
Three-digit plan number (PN) |
504
|
Effective date of plan |
2017-04-01
|
Business code |
541512
|
Sponsor’s telephone number |
6514008759
|
Plan sponsor’s mailing address |
408 SAINT PETER ST STE 600, SAINT PAUL, MN, 551021122
|
Plan sponsor’s
address |
408 SAINT PETER ST STE 600, SAINT PAUL, MN, 551021122
|
Number of participants as of the end of the plan year
Active participants |
959 |
Retired or separated participants receiving
benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2023-07-25 |
Name of individual signing |
JENNALEE POULSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GRANICUS, LLC MEDICAL BENEFIT PLAN
|
2022
|
411941088
|
2023-07-25
|
GRANICUS, LLC
|
616
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2018-01-01
|
Business code |
541512
|
Sponsor’s telephone number |
6514008759
|
Plan sponsor’s mailing address |
408 SAINT PETER ST STE 600, SAINT PAUL, MN, 551021122
|
Plan sponsor’s
address |
408 SAINT PETER ST STE 600, SAINT PAUL, MN, 551021122
|
Number of participants as of the end of the plan year
Active participants |
749 |
Retired or separated participants receiving
benefits |
11 |
Signature of
Role |
Plan administrator |
Date |
2023-06-29 |
Name of individual signing |
JENNALEE POULSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GRANICUS, LLC LONG TERM DISABILITY INSURANCE PLAN
|
2021
|
411941088
|
2022-07-29
|
GRANICUS, LLC
|
554
|
|
File |
View Page
|
Three-digit plan number (PN) |
506
|
Effective date of plan |
2017-04-01
|
Business code |
541512
|
Sponsor’s telephone number |
6514008759
|
Plan sponsor’s mailing address |
408 SAINT PETER ST STE 600, SAINT PAUL, MN, 551021122
|
Plan sponsor’s
address |
408 SAINT PETER ST STE 600, SAINT PAUL, MN, 551021122
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2022-07-29 |
Name of individual signing |
JENNALEE POULSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2022-07-29 |
Name of individual signing |
JENNALEE POULSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GRANICUS, LLC MEDICAL BENEFIT PLAN
|
2021
|
411941088
|
2022-07-28
|
GRANICUS, LLC
|
507
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2018-01-01
|
Business code |
541512
|
Sponsor’s telephone number |
6514008759
|
Plan sponsor’s mailing address |
408 SAINT PETER ST STE 600, SAINT PAUL, MN, 551021122
|
Plan sponsor’s
address |
408 SAINT PETER ST STE 600, SAINT PAUL, MN, 551021122
|
Number of participants as of the end of the plan year
Active participants |
562 |
Retired or separated participants receiving
benefits |
13 |
Signature of
Role |
Plan administrator |
Date |
2022-07-28 |
Name of individual signing |
JENNALEE POULSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GRANICUS, LLC SHORT TERM DISABILITY INSURANCE PLAN
|
2021
|
411941088
|
2022-07-29
|
GRANICUS, LLC
|
554
|
|
File |
View Page
|
Three-digit plan number (PN) |
505
|
Effective date of plan |
2017-04-01
|
Business code |
541512
|
Sponsor’s telephone number |
6514008759
|
Plan sponsor’s mailing address |
408 SAINT PETER ST STE 600, SAINT PAUL, MN, 551021122
|
Plan sponsor’s
address |
408 SAINT PETER ST STE 600, SAINT PAUL, MN, 551021122
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2022-07-29 |
Name of individual signing |
JENNALEE POULSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2022-07-29 |
Name of individual signing |
JENNALEE POULSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GRANICUS, LLC DENTAL INSURANCE PLAN
|
2021
|
411941088
|
2022-07-29
|
GRANICUS, LLC
|
504
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2017-04-01
|
Business code |
541512
|
Sponsor’s telephone number |
6514008759
|
Plan sponsor’s mailing address |
408 SAINT PETER ST STE 600, SAINT PAUL, MN, 551021122
|
Plan sponsor’s
address |
408 SAINT PETER ST STE 600, SAINT PAUL, MN, 551021122
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2022-07-29 |
Name of individual signing |
JENNALEE POULSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2022-07-29 |
Name of individual signing |
JENNALEE POULSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|