TOUCHSTONE MENTAL HEALTH

Three-digit plan number (PN)	997
Effective date of plan	2005-01-01
Business code	621330
Plan sponsor’s mailing address	2312 SNELLING AVE, MINNEAPOLIS, MN, 554043157
Plan sponsor’s address	2312 SNELLING AVE, MINNEAPOLIS, MN, 554043157

Number of participants as of the end of the plan year

Active participants	205
Retired or separated participants receiving benefits	1
Other retired or separated participants entitled to future benefits	0

Signature of

Role	Plan administrator
Date	2023-10-16
Name of individual signing	ELEANOR SKELTON
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2023-10-16
Name of individual signing	ELEANOR SKELTON
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1991-01-01
Business code	621340
Sponsor’s telephone number	6127672183
Plan sponsor’s address	2312 SNELLING AVENUE, MINNEAPOLIS, MN, 55404

Signature of

Role	Plan administrator
Date	2014-10-01
Name of individual signing	HILKE RIECHARDT-MARTINEZ
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1991-01-01
Business code	621340
Sponsor’s telephone number	6128746409
Plan sponsor’s address	1925 NICOLLET AVENUE SOUTH, MINNEAPOLIS, MN, 55403

Signature of

Role	Plan administrator
Date	2013-07-24
Name of individual signing	MARTHA LANTZ
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1991-01-01
Business code	621340
Sponsor’s telephone number	6127672183
Plan sponsor’s address	2829 UNIVERSITY AVENUE SE, SUITE 400, MINNEAPOLIS, MN, 55414

Plan administrator’s name and address

Administrator’s EIN	411920740
Plan administrator’s name	TOUCHSTONE MENTAL HEALTH
Plan administrator’s address	2829 UNIVERSITY AVENUE SE, SUITE 400, MINNEAPOLIS, MN, 55414
Administrator’s telephone number	6127672183

Signature of

Role	Plan administrator
Date	2012-05-31
Name of individual signing	MARTHA LANTZ
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1991-01-01
Business code	621340
Sponsor’s telephone number	6127672183
Plan sponsor’s address	2829 UNIVERSITY AVENUE SE SUITE 400, MINNEAPOLIS, MN, 55414

Plan administrator’s name and address

Administrator’s EIN	411920740
Plan administrator’s name	TOUCHSTONE MENTAL HEALTH
Plan administrator’s address	2829 UNIVERSITY AVENUE SE SUITE 400, MINNEAPOLIS, MN, 55414
Administrator’s telephone number	6127672183

Signature of

Role	Plan administrator
Date	2011-05-26
Name of individual signing	MARTHA LANTZ
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1991-01-01
Business code	621340
Sponsor’s telephone number	6127672162
Plan sponsor’s address	2829 UNIVERSITY AVENUE SE SUITE 400, MINNEAPOLIS, MN, 55414

Plan administrator’s name and address

Administrator’s EIN	411920740
Plan administrator’s name	TOUCHSTONE MENTAL HEALTH
Plan administrator’s address	2829 UNIVERSITY AVENUE SE SUITE 400, MINNEAPOLIS, MN, 55414
Administrator’s telephone number	6127672162

Signature of

Role	Plan administrator
Date	2010-07-08
Name of individual signing	MARTHA LANTZ
Valid signature	Filed with authorized/valid electronic signature