FORUM STAFFING SERVICES SELF FUNDED MEDICAL PLAN
|
2021
|
134037253
|
2022-07-25
|
FORUM CONSULTING SERVICES INC.
|
111
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2016-01-01
|
Business code |
561300
|
Sponsor’s telephone number |
2126874050
|
Plan
sponsor’s DBA name |
THE FORUM GROUP
|
Plan sponsor’s mailing address |
550 7TH AVENUE 21ST FLOOR, NEW YORK, NY, 10018
|
Plan sponsor’s
address |
550 7TH AVENUE 21ST FLOOR, NEW YORK, NY, 10018
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2022-07-25 |
Name of individual signing |
DEAN HERNAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
FORUM STAFFING SERVICES SELF FUNDED MEDICAL PLAN
|
2020
|
134037253
|
2021-08-25
|
FORUM CONSULTING SERVICES INC.
|
10
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2016-01-01
|
Business code |
561300
|
Sponsor’s telephone number |
2126874050
|
Plan sponsor’s mailing address |
550 7TH AVE FL 21, NEW YORK, NY, 100183224
|
Plan sponsor’s
address |
550 7TH AVE FL 21, NEW YORK, NY, 100183224
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2021-08-25 |
Name of individual signing |
DEAN HERNAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
FORUM STAFFING SERVICES SELF FUNDED MEDICAL PLAN
|
2018
|
134037253
|
2019-07-22
|
FORUM CONSULTING SERVICES INC.
|
150
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2016-01-01
|
Business code |
561300
|
Sponsor’s telephone number |
2126874050
|
Plan sponsor’s mailing address |
260 MADISON AVENUE SUITE 200, NEW YORK, NY, 100162430
|
Plan sponsor’s
address |
260 MADISON AVENUE SUITE 200, NEW YORK, NY, 100162430
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2019-07-22 |
Name of individual signing |
DEAN HERNAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
FORUM STAFFING SERVICES SELF FUNDED MEDICAL PLAN
|
2017
|
134037253
|
2018-10-04
|
FORUM CONSULTING SERVICES INC.
|
188
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2016-01-01
|
Business code |
561300
|
Sponsor’s telephone number |
2126874050
|
Plan sponsor’s mailing address |
260 MADISON AVE STE 200, NEW YORK, NY, 100162430
|
Plan sponsor’s
address |
260 MADISON AVE STE 200, NEW YORK, NY, 100162430
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2018-10-04 |
Name of individual signing |
DEAN HERNAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
FORUM STAFFING SERVICES SELF FUNDED MEDICAL PLAN
|
2016
|
134037253
|
2017-10-10
|
FORUM CONSULTING SERVICES INC.
|
57
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2016-01-01
|
Business code |
561300
|
Sponsor’s telephone number |
2126874050
|
Plan
sponsor’s DBA name |
FORUM STAFFING SERVICES
|
Plan sponsor’s mailing address |
260 MADISON AVE STE 200, NEW YORK, NY, 100162430
|
Plan sponsor’s
address |
260 MADISON AVE STE 200, NEW YORK, NY, 100162430
|
Number of participants as of the end of the plan year
Active participants |
188 |
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 |
2017-10-10 |
Name of individual signing |
DEAN HERNAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
FORUM STAFFING SERVICES SELF FUNDED MEDICAL PLAN
|
2016
|
134037253
|
2017-10-09
|
FORUM CONSULTING SERVICES INC.
|
57
|
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2016-01-01
|
Business code |
561300
|
Sponsor’s telephone number |
2126874050
|
Plan
sponsor’s DBA name |
FORUM STAFFING SERVICES
|
Plan sponsor’s mailing address |
260 MADISON AVE STE 200, NEW YORK, NY, 100162430
|
Plan sponsor’s
address |
260 MADISON AVE STE 200, NEW YORK, NY, 100162430
|
Number of participants as of the end of the plan year
Active participants |
188 |
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 |
2017-10-09 |
Name of individual signing |
DEAN HERNAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|