COMMUNITY OPTIONS INC. LIFE/AD&D PLAN
|
2019
|
840626085
|
2021-01-29
|
COMMUNITY OPTIONS, INC.
|
106
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
2005-07-01
|
Business code |
623000
|
Sponsor’s telephone number |
9702491412
|
Plan sponsor’s mailing address |
PO BOX 31, MONTROSE, CO, 814020031
|
Plan sponsor’s
address |
336 S. 10TH ST., MONTROSE, CO, 81401
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2021-01-29 |
Name of individual signing |
STEVE DAHLMAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2021-01-29 |
Name of individual signing |
STEVE DAHLMAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
COMMUNITY OPTIONS INC. LIFE / AD& D PLAN
|
2018
|
840626085
|
2020-01-31
|
COMMUNITY OPTIONS INC.
|
113
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
2005-07-01
|
Business code |
623000
|
Sponsor’s telephone number |
9702491412
|
Plan sponsor’s mailing address |
PO BOX 31, MONTROSE, CO, 814020031
|
Plan sponsor’s
address |
336 S. 10TH ST., MONTROSE, CO, 81401
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2020-01-31 |
Name of individual signing |
STEVE DAHLMAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2020-01-31 |
Name of individual signing |
STEVE DAHLMAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
COMMUNITY OPTIONS INC. LIFE / AD&D PLAN
|
2017
|
840626085
|
2019-01-24
|
COMMUNITY OPTIONS INC.
|
114
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
2005-07-01
|
Business code |
623000
|
Sponsor’s telephone number |
9702491412
|
Plan sponsor’s mailing address |
PO BOX 31, MONTROSE, CO, 814020031
|
Plan sponsor’s
address |
336 S. 10TH STREET, 336 S. 10TH ST., MONTROSE, CO, 81401
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2019-01-24 |
Name of individual signing |
STEVE DAHLMAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2019-01-24 |
Name of individual signing |
STEVE DAHLMAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
COMMUNITY OPTIONS MEDICAL BENEFITS PLAN
|
2016
|
840626085
|
2018-02-02
|
COMMUNITY OPTIONS, INC.
|
76
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2003-07-01
|
Business code |
623000
|
Sponsor’s telephone number |
9702491412
|
Plan sponsor’s mailing address |
PO BOX 31, MONTROSE, CO, 814020031
|
Plan sponsor’s
address |
336 S. 10TH STREET, MONTROSE, CO, 81401
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2018-02-02 |
Name of individual signing |
STEVE DAHLMAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-02-02 |
Name of individual signing |
STEVE DAHLMAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
COMMUNITY OPTIONS INC. LIFE / AD&D PLAN
|
2016
|
840626085
|
2018-02-09
|
COMMUNITY OPTIONS, INC.
|
135
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
2005-07-01
|
Business code |
623000
|
Sponsor’s telephone number |
9702491412
|
Plan sponsor’s mailing address |
PO BOX 31, MONTROSE, CO, 814020031
|
Plan sponsor’s
address |
336 S. 10TH STREET, MONTROSE, CO, 81401
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2018-02-09 |
Name of individual signing |
STEVE DAHLMAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-02-09 |
Name of individual signing |
STEVE DAHLMAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
COMMUNITY OPTIONS, INC. LIFE / AD&D BENEFIT PLAN
|
2015
|
840626085
|
2017-01-25
|
COMMUNITY OPTIONS, INC.
|
145
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
2005-07-01
|
Business code |
623000
|
Sponsor’s telephone number |
9702491412
|
Plan sponsor’s mailing address |
PO BOX 31, MONTROSE, CO, 814020031
|
Plan sponsor’s
address |
336 S. 10TH STREET, MONTROSE, CO, 81401
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2017-01-25 |
Name of individual signing |
STEVE DAHLMAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2017-01-25 |
Name of individual signing |
STEVE DAHLMAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
COMMUNITY OPTIONS MEDICAL BENEFITS PLAN
|
2015
|
840626085
|
2017-01-25
|
COMMUNITY OPTIONS, INC.
|
84
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2003-07-01
|
Business code |
623000
|
Sponsor’s telephone number |
9702491412
|
Plan sponsor’s mailing address |
PO BOX 31, MONTROSE, CO, 814020031
|
Plan sponsor’s
address |
336 S. 10TH STREET, MONTROSE, CO, 81401
|
Plan administrator’s name and address
Administrator’s EIN |
840626085 |
Plan administrator’s name |
COMMUNITY OPTIONS, INC. |
Plan administrator’s
address |
PO BOX 31, MONTROSE, CO, 814020031 |
Administrator’s telephone number |
9702491412 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2017-01-25 |
Name of individual signing |
STEVE DAHLMAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2017-01-25 |
Name of individual signing |
STEVE DAHLMAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
COMMUNITY OPTIONS LIFE / AD&D BENEFIT PLAN
|
2014
|
840626085
|
2016-01-29
|
COMMUNITY OPTIONS, INC.
|
136
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
2005-07-01
|
Business code |
623000
|
Sponsor’s telephone number |
9702491412
|
Plan sponsor’s mailing address |
P.O. BOX 31, MONTROSE, CO, 814020031
|
Plan sponsor’s
address |
336 S. 10TH STREET, MONTROSE, CO, 81401
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2016-01-29 |
Name of individual signing |
STEVE DAHLMAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2016-01-29 |
Name of individual signing |
STEVE DAHLMAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
COMMUNITY OPTIONS LIFE / AD&D BENEFIT PLAN
|
2013
|
840626085
|
2014-12-18
|
COMMUNITY OPTIONS, INC.
|
144
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
2005-07-01
|
Business code |
623000
|
Sponsor’s telephone number |
9702491412
|
Plan sponsor’s mailing address |
P.O. BOX 31, MONTROSE, CO, 814020031
|
Plan sponsor’s
address |
336 S. 10TH STREET, MONTROSE, CO, 81401
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2014-12-18 |
Name of individual signing |
STEVE DAHLMAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2014-12-18 |
Name of individual signing |
STEVE DAHLMAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
COMMUNITY OPTIONS MEDICAL BENEFITS PLAN
|
2013
|
840626085
|
2014-12-18
|
COMMUNITY OPTIONS, INC.
|
100
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2003-07-01
|
Business code |
623000
|
Sponsor’s telephone number |
9702491412
|
Plan sponsor’s mailing address |
P.O. BOX 31, MONTROSE, CO, 814020031
|
Plan sponsor’s
address |
336 S. 10TH STREET, MONTROSE, CO, 81401
|
Number of participants as of the end of the plan year
Active participants |
79 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2014-12-18 |
Name of individual signing |
STEVE DAHLMAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2014-12-18 |
Name of individual signing |
STEVE DAHLMAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|