COMMUNITY OPTIONS GROUP LIFE INSURANCE PLAN
|
2014
|
061300693
|
2015-11-03
|
COMMUNITY OPTIONS, INC.
|
186
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
2004-08-01
|
Business code |
623000
|
Sponsor’s telephone number |
2037574921
|
Plan sponsor’s mailing address |
562 WATERTOWN AVENUE, SUITE 3, WATERBURY, CT, 06708
|
Plan sponsor’s
address |
562 WATERTOWN AVENUE, SUITE 3, WATERBURY, CT, 06708
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2015-11-03 |
Name of individual signing |
JAMES KELLY |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2015-11-03 |
Name of individual signing |
JAMES KELLY |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
COMMUNITY OPTIONS GROUP HEALTH INSURANCE PLAN
|
2014
|
061300693
|
2015-11-03
|
COMMUNITY OPTIONS, INC.
|
100
|
|
File |
View Page
|
Three-digit plan number (PN) |
508
|
Effective date of plan |
1997-08-01
|
Business code |
623000
|
Sponsor’s telephone number |
2037574921
|
Plan sponsor’s mailing address |
562 WATERTOWN AVENUE, SUITE 3, WATERBURY, CT, 06708
|
Plan sponsor’s
address |
562 WATERTOWN AVENUE, SUITE 3, WATERBURY, CT, 06708
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2015-11-03 |
Name of individual signing |
JAMES KELLY |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2015-11-03 |
Name of individual signing |
JAMES KELLY |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
COMMUNITY OPTIONS GROUP HEALTH INSURANCE PLAN
|
2013
|
061300693
|
2014-10-22
|
COMMUNITY OPTIONS, INC.
|
115
|
|
File |
View Page
|
Three-digit plan number (PN) |
508
|
Effective date of plan |
1997-08-01
|
Business code |
623000
|
Sponsor’s telephone number |
2037574921
|
Plan sponsor’s mailing address |
562 WATERTOWN AVENUE, SUITE 3, WATERBURY, CT, 06708
|
Plan sponsor’s
address |
562 WATERTOWN AVENUE, SUITE 3, WATERBURY, CT, 06708
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2014-10-21 |
Name of individual signing |
JAMES KELLY |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2014-10-21 |
Name of individual signing |
JAMES KELLY |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
COMMUNITY OPTYONNS GROUP LIFE INSURANCE PLAN
|
2013
|
061300693
|
2014-10-22
|
COMMUNITY OPTIONS, INC.
|
203
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
2004-08-01
|
Business code |
623000
|
Sponsor’s telephone number |
2037574921
|
Plan sponsor’s mailing address |
562 WATERTOWN AVENUE, SUITE 3, WATERBURY, CT, 06708
|
Plan sponsor’s
address |
562 WATERTOWN AVENUE, SUITE 3, WATERBURY, CT, 06708
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2014-10-21 |
Name of individual signing |
JAMES KELLY |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2014-10-21 |
Name of individual signing |
JAMES KELLY |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
COMMUNITY OPTIONS GROUP LIFE INSURANCE PLAN
|
2012
|
061300693
|
2014-10-22
|
COMMUNITY OPTIONS, INC.
|
201
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1977-08-01
|
Business code |
623000
|
Sponsor’s telephone number |
2037574921
|
Plan sponsor’s mailing address |
562 WATERTOWN AVENUE, SUITE 3, WATERBURY, CT, 06708
|
Plan sponsor’s
address |
562 WATERTOWN AVENUE, SUITE 3, WATERBURY, CT, 06708
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2014-10-21 |
Name of individual signing |
JAMES KELLY |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2014-10-21 |
Name of individual signing |
JAMES KELLY |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
COMMUNITY OPTIONS GROUP HEALTH INSURANCE PLAN
|
2012
|
061300693
|
2014-10-22
|
COMMUNITY OPTIONS, INC.
|
99
|
|
File |
View Page
|
Three-digit plan number (PN) |
508
|
Effective date of plan |
1997-08-01
|
Business code |
623000
|
Sponsor’s telephone number |
2037574921
|
Plan sponsor’s mailing address |
562 WATERTOWN AVENUE, SUITE 3, WATERBURY, CT, 06708
|
Plan sponsor’s
address |
562 WATERTOWN AVENUE, SUITE 3, WATERBURY, CT, 06708
|
Number of participants as of the end of the plan year
Active participants |
115 |
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 |
Number of
participants
with
account balances as of the end of the plan year |
0 |
Number of participants that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
0 |
Signature of
Role |
Plan administrator |
Date |
2014-10-21 |
Name of individual signing |
JAMES KELLY |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2014-10-21 |
Name of individual signing |
JAMES KELLY |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
COMMUNITY OPTIONS GROUP LIFE INSURANCE PLAN
|
2010
|
061300693
|
2012-02-27
|
COMMUNITY OPTIONS, INC.
|
196
|
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1977-08-01
|
Business code |
623000
|
Sponsor’s telephone number |
2037574921
|
Plan sponsor’s mailing address |
562 WATERTOWN AVENUE, SUITE 3, WATERBURY, CT, 06708
|
Plan sponsor’s
address |
562 WATERTOWN AVENUE, SUITE 3, WATERBURY, CT, 06708
|
Plan administrator’s name and address
Administrator’s EIN |
061300693 |
Plan administrator’s name |
COMMUNITY OPTIONS, INC. |
Plan administrator’s
address |
562 WATERTOWN AVENUE, SUITE 3, WATERBURY, CT, 06708 |
Administrator’s telephone number |
2037574921 |
Number of participants as of the end of the plan year
Active participants |
192 |
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 |
Number of
participants
with
account balances as of the end of the plan year |
0 |
Number of participants that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
0 |
Signature of
Role |
Employer/plan sponsor |
Date |
2012-02-27 |
Name of individual signing |
JAMES KELLY |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
COMMUNITY OPTIONS GROUP LIFE INSURANCE PLAN
|
2010
|
061300693
|
2012-02-27
|
COMMUNITY OPTIONS, INC.
|
196
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1977-08-01
|
Business code |
623000
|
Sponsor’s telephone number |
2037574921
|
Plan sponsor’s mailing address |
562 WATERTOWN AVENUE, SUITE 3, WATERBURY, CT, 06708
|
Plan sponsor’s
address |
562 WATERTOWN AVENUE, SUITE 3, WATERBURY, CT, 06708
|
Plan administrator’s name and address
Administrator’s EIN |
061300693 |
Plan administrator’s name |
COMMUNITY OPTIONS, INC. |
Plan administrator’s
address |
562 WATERTOWN AVENUE, SUITE 3, WATERBURY, CT, 06708 |
Administrator’s telephone number |
2037574921 |
Number of participants as of the end of the plan year
Active participants |
192 |
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 |
Number of
participants
with
account balances as of the end of the plan year |
0 |
Number of participants that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
0 |
Signature of
Role |
Plan administrator |
Date |
2012-02-27 |
Name of individual signing |
JAMES KELLY |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
COMMUNITY OPTIONS GROUP LIFE INSURANCE PLAN
|
2010
|
061300693
|
2012-02-27
|
COMMUNITY OPTIONS, INC.
|
196
|
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1977-08-01
|
Business code |
623000
|
Sponsor’s telephone number |
2037574921
|
Plan sponsor’s mailing address |
562 WATERTOWN AVENUE, SUITE 3, WATERBURY, CT, 06708
|
Plan sponsor’s
address |
562 WATERTOWN AVENUE, SUITE 3, WATERBURY, CT, 06708
|
Plan administrator’s name and address
Administrator’s EIN |
061300693 |
Plan administrator’s name |
COMMUNITY OPTIONS, INC. |
Plan administrator’s
address |
562 WATERTOWN AVENUE, SUITE 3, WATERBURY, CT, 06708 |
Administrator’s telephone number |
2037574921 |
Number of participants as of the end of the plan year
Active participants |
192 |
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 |
Number of
participants
with
account balances as of the end of the plan year |
0 |
Number of participants that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
0 |
Signature of
Role |
Employer/plan sponsor |
Date |
2012-02-27 |
Name of individual signing |
JAMES KELLY |
Valid signature |
Filed with authorized/valid electronic signature |
|
|