|
TRI-COUNTY HEALTH CARE MEDICAL PLAN
|
2015
|
410713913
|
2016-07-29
|
TRI-COUNTY HEALTH CARE
|
294
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
1988-04-01
|
| Business code |
622000
|
| Sponsor’s telephone number |
2186313510
|
| Plan sponsor’s mailing address |
415 JEFFERSON ST N, WADENA, MN, 564821264
|
| Plan sponsor’s
address |
415 JEFFERSON ST N, WADENA, MN, 564821264
|
Number of participants as of the end of the plan year
Signature of
| Role |
Plan administrator |
| Date |
2016-07-29 |
| Name of individual signing |
TERESA JOHNSON |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2016-07-29 |
| Name of individual signing |
TERESA JOHNSON |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
TRI COUNTY HEALTH CARE
|
2015
|
410713913
|
2016-08-01
|
TRI COUNTY HEALTH CARE
|
302
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
502
|
| Effective date of plan |
1988-04-01
|
| Business code |
622000
|
| Sponsor’s telephone number |
2186313510
|
| Plan sponsor’s mailing address |
415 JEFFERSON ST N, WADENA, MN, 564821264
|
| Plan sponsor’s
address |
415 JEFFERSON ST N, WADENA, MN, 564821264
|
Number of participants as of the end of the plan year
Signature of
| Role |
Plan administrator |
| Date |
2016-08-01 |
| Name of individual signing |
TERESA JOHNSON |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2016-08-01 |
| Name of individual signing |
TERESA JOHNSON |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
TRI COUNTY HEALTH CARE MEDICAL PLAN
|
2014
|
410713913
|
2016-07-27
|
TRI COUNTY HEALTH CARE
|
659
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2014-01-01
|
| Business code |
622000
|
| Sponsor’s telephone number |
2186313510
|
| Plan sponsor’s mailing address |
415 JEFFERSON ST. N, WADENA, MN, 56482
|
| Plan sponsor’s
address |
415 JEFFERSON ST. N, WADENA, MN, 56482
|
Number of participants as of the end of the plan year
Signature of
| Role |
Plan administrator |
| Date |
2016-07-27 |
| Name of individual signing |
TERESA JOHNSON |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2016-07-27 |
| Name of individual signing |
TERESA JOHNSON |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
