LIFE AND DISABILITY PLAN
|
2019
|
161020913
|
2020-09-14
|
OAK ORCHARD COMMUNITY HEALTH CENTER, INC.
|
177
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
1993-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
5856373905
|
Plan sponsor’s mailing address |
300 WEST AVE, BROCKPORT, NY, 144201118
|
Plan sponsor’s
address |
300 WEST AVE, BROCKPORT, NY, 144201118
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2020-09-14 |
Name of individual signing |
URSULA STANEFF |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2020-09-14 |
Name of individual signing |
URSULA STANEFF |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
HEALTH PLAN
|
2019
|
161020913
|
2020-09-14
|
OAK ORCHARD COMMUNITY HEALTH CENTER, INC.
|
91
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1993-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
5856373905
|
Plan sponsor’s mailing address |
300 WEST AVE, BROCKPORT, NY, 144201118
|
Plan sponsor’s
address |
300 WEST AVE, BROCKPORT, NY, 144201118
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2020-09-14 |
Name of individual signing |
URSULA STANEFF |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2020-09-14 |
Name of individual signing |
URSULA STANEFF |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
OAK ORCHARD HEALTH 403(B) PLAN
|
2019
|
161020913
|
2020-10-13
|
OAK ORCHARD COMMUNITY HEALTH CENTER, INC.
|
96
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2009-12-10
|
Business code |
621399
|
Sponsor’s telephone number |
5856373905
|
Plan sponsor’s
address |
300 WEST AVENUE, BROCKPORT, NY, 14420
|
|
LIFE AND DISABILITY PLAN
|
2018
|
161020913
|
2019-07-29
|
OAK ORCHARD COMMUNITY HEALTH CENTER, INC.
|
177
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
1993-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
5856373905
|
Plan sponsor’s mailing address |
300 WEST AVE, BROCKPORT, NY, 144201118
|
Plan sponsor’s
address |
300 WEST AVE, BROCKPORT, NY, 144201118
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2019-07-29 |
Name of individual signing |
CAROL WHITE |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2019-07-29 |
Name of individual signing |
CAROL WHITE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
HEALTH PLAN
|
2018
|
161020913
|
2019-07-25
|
OAK ORCHARD COMMUNITY HEALTH CENTER, INC.
|
90
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1993-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
5856373905
|
Plan sponsor’s mailing address |
300 WEST AVE, BROCKPORT, NY, 144201118
|
Plan sponsor’s
address |
300 WEST AVE, BROCKPORT, NY, 144201118
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2019-07-25 |
Name of individual signing |
CAROL WHITE |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2019-07-25 |
Name of individual signing |
CAROL WHITE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LIFE AND DISABILITY PLAN
|
2017
|
161020913
|
2018-07-31
|
OAK ORCHARD COMMUNITY HEALTH CENTER, INC.
|
161
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
1993-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
5856373905
|
Plan sponsor’s mailing address |
300 WEST AVE, BROCKPORT, NY, 144201118
|
Plan sponsor’s
address |
300 WEST AVE, BROCKPORT, NY, 144201118
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2018-07-31 |
Name of individual signing |
CAROL WHITE |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-07-31 |
Name of individual signing |
CAROL WHITE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
HEALTH PLAN
|
2017
|
161020913
|
2018-07-31
|
OAK ORCHARD COMMUNITY HEALTH CENTER, INC.
|
94
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1993-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
5856373905
|
Plan sponsor’s mailing address |
300 WEST AVE, BROCKPORT, NY, 144201118
|
Plan sponsor’s
address |
300 WEST AVE, BROCKPORT, NY, 144201118
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2018-07-31 |
Name of individual signing |
CAROL WHITE |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-07-31 |
Name of individual signing |
CAROL WHITE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
HEALTH PLAN
|
2016
|
161020913
|
2017-09-27
|
OAK ORCHARD COMMUNITY HEALTH CENTER, INC.
|
134
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1993-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
5856373905
|
Plan sponsor’s mailing address |
300 WEST AVE, BROCKPORT, NY, 144201118
|
Plan sponsor’s
address |
300 WEST AVE, BROCKPORT, NY, 144201118
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2017-09-27 |
Name of individual signing |
CAROL WHITE |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2017-09-27 |
Name of individual signing |
CAROL WHITE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LIFE AND DISABLILTY PLAN
|
2016
|
161020913
|
2017-07-27
|
OAK ORCHARD COMMUNITY HEALTH CENTER, INC.
|
139
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
1993-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
5856373905
|
Plan sponsor’s mailing address |
300 WEST AVE, BROCKPORT, NY, 144201118
|
Plan sponsor’s
address |
300 WEST AVE, BROCKPORT, NY, 14420
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2017-07-27 |
Name of individual signing |
CAROL WHITE |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2017-07-27 |
Name of individual signing |
CAROL WHITE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LIFE AND DISABLILTY PLAN
|
2015
|
161020913
|
2016-07-26
|
OAK ORCHARD COMMUNITY HEALTH CENTER, INC.
|
126
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
1993-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
5856373905
|
Plan sponsor’s mailing address |
300 WEST AVE, BROCKPORT, NY, 144201118
|
Plan sponsor’s
address |
300 WEST AVE, BROCKPORT, NY, 144201118
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2016-07-26 |
Name of individual signing |
CAROL WHITE |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2016-07-26 |
Name of individual signing |
CAROL WHITE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|