|
CENTRACARE CLINIC GROUP HEALTH PLAN
|
2010
|
411806657
|
2011-07-26
|
CENTRACARE CLINIC
|
199
|
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
1987-09-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
3202402152
|
| Plan sponsor’s mailing address |
1200 6TH AVE N, ST CLOUD, MN, 56303
|
| Plan sponsor’s
address |
1200 6TH AVE N, ST CLOUD, MN, 56303
|
Plan administrator’s name and address
| Administrator’s EIN |
411806657 |
| Plan administrator’s name |
CENTRACARE CLINIC |
| Plan administrator’s
address |
1200 6TH AVE N, ST CLOUD, MN, 56303 |
| Administrator’s telephone number |
3202402152 |
Number of participants as of the end of the plan year
Signature of
| Role |
Employer/plan sponsor |
| Date |
2011-07-26 |
| Name of individual signing |
TOM FELDHEGE |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
CENTRACARE CLINIC GROUP HEALTH PLAN
|
2010
|
411806657
|
2011-07-28
|
CENTRACARE CLINIC
|
199
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
1987-09-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
3202402152
|
| Plan sponsor’s mailing address |
1200 6TH AVE N, ST CLOUD, MN, 56303
|
| Plan sponsor’s
address |
1200 6TH AVE N, ST CLOUD, MN, 56303
|
Plan administrator’s name and address
| Administrator’s EIN |
411806657 |
| Plan administrator’s name |
CENTRACARE CLINIC |
| Plan administrator’s
address |
1200 6TH AVE N, ST CLOUD, MN, 56303 |
| Administrator’s telephone number |
3202402152 |
Number of participants as of the end of the plan year
Signature of
| Role |
Plan administrator |
| Date |
2011-07-27 |
| Name of individual signing |
TOM FELDHEGE |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
CENTRACARE CLINIC GROUP HEALTH PLAN
|
2009
|
411806657
|
2010-07-13
|
CENTRACARE CLINIC
|
194
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
1987-09-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
3202402152
|
| Plan sponsor’s mailing address |
1200 6TH AVE N, ST CLOUD, MN, 56303
|
| Plan sponsor’s
address |
1200 6TH AVE N, ST CLOUD, MN, 56303
|
Plan administrator’s name and address
| Administrator’s EIN |
411806657 |
| Plan administrator’s name |
CENTRACARE CLINIC |
| Plan administrator’s
address |
1200 6TH AVE N, ST CLOUD, MN, 56303 |
| Administrator’s telephone number |
3202402152 |
Number of participants as of the end of the plan year
Signature of
| Role |
Plan administrator |
| Date |
2010-07-13 |
| Name of individual signing |
TOM FELDHEGE |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2010-07-13 |
| Name of individual signing |
TOM FELDHEGE |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
CENTRACARE CLINIC GROUP HEALTH PLAN
|
2009
|
411806657
|
2010-07-13
|
CENTRACARE CLINIC
|
194
|
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
1987-09-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
3202402152
|
| Plan sponsor’s mailing address |
1200 6TH AVE N, ST CLOUD, MN, 56303
|
| Plan sponsor’s
address |
1200 6TH AVE N, ST CLOUD, MN, 56303
|
Plan administrator’s name and address
| Administrator’s EIN |
411806657 |
| Plan administrator’s name |
CENTRACARE CLINIC |
| Plan administrator’s
address |
1200 6TH AVE N, ST CLOUD, MN, 56303 |
| Administrator’s telephone number |
3202402152 |
Number of participants as of the end of the plan year
Signature of
| Role |
Employer/plan sponsor |
| Date |
2010-07-13 |
| Name of individual signing |
TOM FELDHEGE |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
