RANGE MENTAL HEALTH CENTER, INC. DENTAL PLAN
|
2021
|
410849301
|
2022-10-20
|
RANGE MENTAL HEALTH CENTER, INC.
|
111
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1994-07-01
|
Business code |
621330
|
Sponsor’s telephone number |
2187492881
|
Plan sponsor’s mailing address |
PO BOX 1188, 624 - 13TH STREET SOUTH, VIRGINIA, MN, 557921188
|
Plan sponsor’s
address |
PO BOX 1188, 624 - 13TH STREET SOUTH, VIRGINIA, MN, 557921188
|
Number of participants as of the end of the plan year
Active participants |
83 |
Retired or separated participants receiving
benefits |
2 |
Signature of
Role |
Plan administrator |
Date |
2022-10-20 |
Name of individual signing |
KATHRYN SCHULZETENBERG |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
RANGE MENTAL HEALTH CENTER, INC. LIFE INSURANCE PLAN
|
2021
|
410849301
|
2022-11-03
|
RANGE MENTAL HEALTH CENTER, INC.
|
113
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1961-06-01
|
Business code |
621330
|
Sponsor’s telephone number |
2187492881
|
Plan sponsor’s mailing address |
PO BOX 1188, 624 13TH STREET SOUTH, VIRGINIA, MN, 55792
|
Plan sponsor’s
address |
P.O. BOX 1188, 624 13TH STREET SOUTH, VIRGINIA, MN, 55792
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2022-11-02 |
Name of individual signing |
KATHRYN SCHULZETENBERG |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
RANGE MENTAL HEALTH CENTER, INC. SHORT TERM DISABILITY PLAN
|
2021
|
410849301
|
2022-11-03
|
RANGE MENTAL HEALTH CENTER, INC.
|
110
|
|
File |
View Page
|
Three-digit plan number (PN) |
505
|
Effective date of plan |
1999-01-01
|
Business code |
621330
|
Sponsor’s telephone number |
2187492881
|
Plan sponsor’s mailing address |
P.O. BOX 1188, 624 13TH STREET SOUTH, VIRGINIA, MN, 55792
|
Plan sponsor’s
address |
P.O. BOX 1188, 624 13TH STREET SOUTH, VIRGINIA, MN, 55792
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2022-11-02 |
Name of individual signing |
KATHRYN SCHULZETENBERG |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
RANGE MENTAL HEALTH CENTER, INC. LONG TERM DISABILITY PLAN
|
2021
|
410849301
|
2022-11-03
|
RANGE MENTAL HEALTH CENTER, INC.
|
110
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
1980-01-01
|
Business code |
621330
|
Sponsor’s telephone number |
2187492881
|
Plan sponsor’s mailing address |
P.O. BOX 1188, 624 13TH STREET SOUTH, VIRGINIA, MN, 55792
|
Plan sponsor’s
address |
P.O. BOX 1188, 624 13TH STREET SOUTH, VIRGINIA, MN, 55792
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2022-11-02 |
Name of individual signing |
KATIE SCHULZETENBERG |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
RANGE MENTAL HEALTH CENTER, INC. SHORT TERM DISABILITY PLAN
|
2020
|
410849301
|
2021-10-08
|
RANGE MENTAL HEALTH CENTER, INC.
|
138
|
|
File |
View Page
|
Three-digit plan number (PN) |
505
|
Effective date of plan |
1999-01-01
|
Business code |
621330
|
Sponsor’s telephone number |
2187492881
|
Plan sponsor’s mailing address |
P.O. BOX 1188, 624 13TH STREET SOUTH, VIRGINIA, MN, 55792
|
Plan sponsor’s
address |
P.O. BOX 1188, 624 13TH STREET SOUTH, VIRGINIA, MN, 55792
|
Number of participants as of the end of the plan year
Active participants |
107 |
Retired or separated participants receiving
benefits |
3 |
Signature of
Role |
Plan administrator |
Date |
2021-10-08 |
Name of individual signing |
KARRI SCHUTTE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
RANGE MENTAL HEALTH CENTER, INC. LIFE INSURANCE PLAN
|
2020
|
410849301
|
2021-10-08
|
RANGE MENTAL HEALTH CENTER, INC.
|
138
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1961-06-01
|
Business code |
621330
|
Sponsor’s telephone number |
2187492881
|
Plan sponsor’s mailing address |
PO BOX 1188, 624 13TH STREET SOUTH, VIRGINIA, MN, 55792
|
Plan sponsor’s
address |
P.O. BOX 1188, 624 13TH STREET SOUTH, VIRGINIA, MN, 55792
|
Number of participants as of the end of the plan year
Active participants |
110 |
Retired or separated participants receiving
benefits |
3 |
Signature of
Role |
Plan administrator |
Date |
2021-10-08 |
Name of individual signing |
KARRI SCHUTTE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
RANGE MENTAL HEALTH CENTER, INC. DENTAL PLAN
|
2020
|
410849301
|
2021-10-08
|
RANGE MENTAL HEALTH CENTER, INC.
|
137
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1994-07-01
|
Business code |
621330
|
Sponsor’s telephone number |
2187492881
|
Plan sponsor’s mailing address |
PO BOX 1188, 624 - 13TH STREET SOUTH, VIRGINIA, MN, 557921188
|
Plan sponsor’s
address |
PO BOX 1188, 624 - 13TH STREET SOUTH, VIRGINIA, MN, 557921188
|
Number of participants as of the end of the plan year
Active participants |
108 |
Retired or separated participants receiving
benefits |
3 |
Signature of
Role |
Plan administrator |
Date |
2021-10-08 |
Name of individual signing |
KARRI SCHUTTE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
RANGE MENTAL HEALTH CENTER, INC. LONG TERM DISABILITY PLAN
|
2020
|
410849301
|
2021-10-08
|
RANGE MENTAL HEALTH CENTER, INC.
|
138
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
1980-01-01
|
Business code |
621330
|
Sponsor’s telephone number |
2187492881
|
Plan sponsor’s mailing address |
P.O. BOX 1188, 624 13TH STREET SOUTH, VIRGINIA, MN, 55792
|
Plan sponsor’s
address |
P.O. BOX 1188, 624 13TH STREET SOUTH, VIRGINIA, MN, 55792
|
Number of participants as of the end of the plan year
Active participants |
107 |
Retired or separated participants receiving
benefits |
3 |
Signature of
Role |
Plan administrator |
Date |
2021-10-08 |
Name of individual signing |
KARRI SCHUTTE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
RANGE MENTAL HEALTH CENTER, INC. DENTAL PLAN
|
2019
|
410849301
|
2020-10-09
|
RANGE MENTAL HEALTH CENTER, INC.
|
147
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1994-07-01
|
Business code |
621330
|
Sponsor’s telephone number |
2187492881
|
Plan sponsor’s mailing address |
PO BOX 1188, 624 - 13TH STREET SOUTH, VIRGINIA, MN, 557921188
|
Plan sponsor’s
address |
PO BOX 1188, 624 - 13TH STREET SOUTH, VIRGINIA, MN, 557921188
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2020-10-08 |
Name of individual signing |
KARRI SCHUTTE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
RANGE MENTAL HEALTH CENTER, INC. LIFE INSURANCE PLAN
|
2019
|
410849301
|
2020-10-09
|
RANGE MENTAL HEALTH CENTER, INC.
|
142
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1961-06-01
|
Business code |
621330
|
Sponsor’s telephone number |
2187492881
|
Plan sponsor’s mailing address |
PO BOX 1188, 624 13TH STREET SOUTH, VIRGINIA, MN, 55792
|
Plan sponsor’s
address |
P.O. BOX 1188, 624 13TH STREET SOUTH, VIRGINIA, MN, 55792
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2020-10-08 |
Name of individual signing |
KARRI SCHUTTE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|