NORBERT E. MITCHELL GROUP HEALTH PLAN
|
2023
|
061173716
|
2024-07-22
|
NORBERT E. MITCHELL CO., INC.
|
119
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2023-01-01
|
Business code |
454310
|
Sponsor’s telephone number |
2037440600
|
Plan sponsor’s mailing address |
PO BOX 186, DANBURY, CT, 068130186
|
Plan sponsor’s
address |
7 FEDERAL ROAD, DANBURY, CT, 06810
|
Plan administrator’s name and address
Administrator’s EIN |
391995276 |
Plan administrator’s name |
UMR, INC |
Plan administrator’s
address |
11 SCOTT ST STE 100, WAUSAU, WI, 544034888 |
Administrator’s telephone number |
8668810800 |
Number of participants as of the end of the plan year
Active participants |
113 |
Retired or separated participants receiving
benefits |
1 |
Signature of
Role |
Plan administrator |
Date |
2024-07-22 |
Name of individual signing |
ANDY MONGAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2024-07-22 |
Name of individual signing |
ANDY MONGAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
NORBERT E. MITCHELL GROUP HEALTH PLAN
|
2022
|
061173716
|
2023-07-27
|
NORBERT E. MITCHELL CO., INC.
|
116
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2022-01-01
|
Business code |
454310
|
Sponsor’s telephone number |
2037440600
|
Plan sponsor’s mailing address |
PO BOX 186, DANBURY, CT, 068130186
|
Plan sponsor’s
address |
7 FEDERAL ROAD, DANBURY, CT, 06810
|
Plan administrator’s name and address
Administrator’s EIN |
391995276 |
Plan administrator’s name |
UMR, INC |
Plan administrator’s
address |
11 SCOTT ST STE 100, WAUSAU, WI, 544034888 |
Administrator’s telephone number |
8668810800 |
Number of participants as of the end of the plan year
Active participants |
113 |
Retired or separated participants receiving
benefits |
1 |
Signature of
Role |
Plan administrator |
Date |
2023-07-27 |
Name of individual signing |
ANDY MONGAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2023-07-27 |
Name of individual signing |
ANDY MONGAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
NORBERT E. MITCHELL GROUP HEALTH PLAN
|
2021
|
061173716
|
2022-07-29
|
NORBERT E. MITCHELL CO., INC.
|
111
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2021-01-01
|
Business code |
454310
|
Sponsor’s telephone number |
2037440600
|
Plan sponsor’s mailing address |
PO BOX 186, DANBURY, CT, 068130186
|
Plan sponsor’s
address |
7 FEDERAL ROAD, DANBURY, CT, 06810
|
Plan administrator’s name and address
Administrator’s EIN |
391995276 |
Plan administrator’s name |
UMR, INC. |
Plan administrator’s
address |
11 SCOTT ST STE 100, WAUSAU, WI, 544034888 |
Administrator’s telephone number |
8668810800 |
Number of participants as of the end of the plan year
Active participants |
107 |
Retired or separated participants receiving
benefits |
1 |
Signature of
Role |
Plan administrator |
Date |
2022-07-29 |
Name of individual signing |
ANDY MONGAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2022-07-29 |
Name of individual signing |
ANDY MONGAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
NORBERT E. MITCHELL GROUP HEALTH PLAN
|
2020
|
061173716
|
2021-07-29
|
NORBERT E. MITCHELL CO., INC.
|
115
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2020-01-01
|
Business code |
454310
|
Sponsor’s telephone number |
2037440600
|
Plan sponsor’s mailing address |
PO BOX 186, DANBURY, CT, 068130186
|
Plan sponsor’s
address |
7 FEDERAL ROAD, DANBURY, CT, 06810
|
Plan administrator’s name and address
Administrator’s EIN |
391995276 |
Plan administrator’s name |
UMR, INC. |
Plan administrator’s
address |
11 SCOTT ST STE 100, WAUSAU, WI, 544034888 |
Administrator’s telephone number |
8668810800 |
Number of participants as of the end of the plan year
Active participants |
111 |
Retired or separated participants receiving
benefits |
1 |
Signature of
Role |
Plan administrator |
Date |
2021-07-29 |
Name of individual signing |
ANDY MONGAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2021-07-29 |
Name of individual signing |
ANDY MONGAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
NORBERT E. MITCHELL GROUP HEALTH PLAN
|
2019
|
061173716
|
2020-07-22
|
NORBERT E. MITCHELL CO., INC.
|
106
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2019-01-01
|
Business code |
454310
|
Sponsor’s telephone number |
2037440600
|
Plan sponsor’s mailing address |
PO BOX 186, DANBURY, CT, 068130186
|
Plan sponsor’s
address |
7 FEDERAL ROAD, DANBURY, CT, 06810
|
Plan administrator’s name and address
Administrator’s EIN |
391995276 |
Plan administrator’s name |
UMR, INC. |
Plan administrator’s
address |
11 SCOTT ST STE 100, WAUSAU, WI, 544034888 |
Administrator’s telephone number |
8668810800 |
Number of participants as of the end of the plan year
Active participants |
113 |
Retired or separated participants receiving
benefits |
2 |
Signature of
Role |
Plan administrator |
Date |
2020-07-22 |
Name of individual signing |
ANDY MONGAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2020-07-22 |
Name of individual signing |
ANDY MONGAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
NORBERT E. MITCHELL GROUP HEALTH PLAN
|
2018
|
061173716
|
2019-07-26
|
NORBERT E. MITCHELL CO., INC.
|
119
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2018-10-01
|
Business code |
454310
|
Sponsor’s telephone number |
2037440600
|
Plan sponsor’s mailing address |
PO BOX 186, DANBURY, CT, 068130186
|
Plan sponsor’s
address |
7 FEDERAL ROAD, DANBURY, CT, 06810
|
Plan administrator’s name and address
Administrator’s EIN |
710847266 |
Plan administrator’s name |
HEALTHSCOPE BENEFITS, INC. |
Plan administrator’s
address |
27 CORPORATE HILL DR, LITTLE ROCK, AR, 722054537 |
Administrator’s telephone number |
5012251551 |
Number of participants as of the end of the plan year
Active participants |
107 |
Retired or separated participants receiving
benefits |
2 |
Other
retired or separated participants entitled to future benefits |
2 |
Signature of
Role |
Plan administrator |
Date |
2019-07-26 |
Name of individual signing |
ANDY MONGAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
NORBERT E. MITCHELL GROUP HEALTH PLAN
|
2017
|
061173716
|
2018-10-15
|
NORBERT E. MITCHELL CO., INC.
|
111
|
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2017-01-01
|
Business code |
454310
|
Sponsor’s telephone number |
2037440600
|
Plan sponsor’s mailing address |
PO BOX 186, DANBURY, CT, 068130186
|
Plan sponsor’s
address |
7 FEDERAL ROAD, DANBURY, CT, 06810
|
Plan administrator’s name and address
Administrator’s EIN |
161264154 |
Plan administrator’s name |
MERITAIN HEALTH |
Plan administrator’s
address |
1719 STATE RT 10, PARSIPPANY, NJ, 070544507 |
Administrator’s telephone number |
9734550284 |
Number of participants as of the end of the plan year
Active participants |
109 |
Retired or separated participants receiving
benefits |
1 |
Signature of
Role |
Plan administrator |
Date |
2018-10-15 |
Name of individual signing |
ANDY MONGAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
NORBERT E. MITCHELL GROUP HEALTH PLAN
|
2017
|
061173716
|
2018-10-15
|
NORBERT E. MITCHELL CO., INC.
|
113
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2017-10-01
|
Business code |
454310
|
Sponsor’s telephone number |
2037440600
|
Plan sponsor’s mailing address |
PO BOX 186, DANBURY, CT, 068130186
|
Plan sponsor’s
address |
7 FEDERAL ROAD, DANBURY, CT, 06810
|
Plan administrator’s name and address
Administrator’s EIN |
710847266 |
Plan administrator’s name |
HEALTHSCOPE BENEFITS, INC. |
Plan administrator’s
address |
27 CORPORATE HILL DR, LITTLE ROCK, AR, 722054537 |
Administrator’s telephone number |
5012251551 |
Number of participants as of the end of the plan year
Active participants |
109 |
Retired or separated participants receiving
benefits |
2 |
Signature of
Role |
Plan administrator |
Date |
2018-10-15 |
Name of individual signing |
ANDY MONGAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
NORBERT E. MITCHELL GROUP HEALTH PLAN
|
2016
|
061173716
|
2017-07-24
|
NORBERT E. MITCHELL CO., INC.
|
113
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2016-01-01
|
Business code |
454310
|
Sponsor’s telephone number |
2037440600
|
Plan sponsor’s mailing address |
PO BOX 186, DANBURY, CT, 068130186
|
Plan sponsor’s
address |
7 FEDERAL ROAD, DANBURY, CT, 06810
|
Plan administrator’s name and address
Administrator’s EIN |
161264154 |
Plan administrator’s name |
MERITAIN HEALTH |
Plan administrator’s
address |
1719 STATE RT 10, PARSIPPANY, NJ, 070544507 |
Administrator’s telephone number |
9734550284 |
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 |
2017-07-24 |
Name of individual signing |
ANDY MONGAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2017-07-24 |
Name of individual signing |
ANDY MONGAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
NORBERT E. MITCHELL GROUP HEALTH PLAN
|
2014
|
061173716
|
2015-08-26
|
NORBERT E. MITCHELL CO., INC.
|
102
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2014-01-01
|
Business code |
454310
|
Sponsor’s telephone number |
2037440600
|
Plan sponsor’s mailing address |
PO BOX 186, DANBURY, CT, 06813
|
Plan sponsor’s
address |
7 FEDERAL ROAD, DANBURY, CT, 06810
|
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 |
2015-08-26 |
Name of individual signing |
ANDY MONGAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2015-08-26 |
Name of individual signing |
ANDY MONGAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|