GUTHRIE CORTLAND MEDICAL CENTER DISABILITY PLAN
|
2021
|
150532079
|
2022-07-22
|
GUTHRIE CORTLAND MEDICAL CENTER
|
509
|
|
File |
View Page
|
Three-digit plan number (PN) |
513
|
Effective date of plan |
2005-01-01
|
Business code |
622000
|
Sponsor’s telephone number |
6077563500
|
Plan sponsor’s mailing address |
134 HOMER AVE, CORTLAND, NY, 130451206
|
Plan sponsor’s
address |
134 HOMER AVE, CORTLAND, NY, 130451206
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2022-07-22 |
Name of individual signing |
MARY KING |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2022-07-22 |
Name of individual signing |
MARY KING |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GUTHRIE CORTLAND MEDICAL CENTER GROUP DENTAL AND VISION
|
2021
|
150532079
|
2022-07-22
|
GUTHRIE CORTLAND MEDICAL CENTER
|
445
|
|
File |
View Page
|
Three-digit plan number (PN) |
512
|
Effective date of plan |
2011-01-01
|
Business code |
622000
|
Sponsor’s telephone number |
6077563500
|
Plan sponsor’s mailing address |
134 HOMER AVE, CORTLAND, NY, 130451206
|
Plan sponsor’s
address |
134 HOMER AVE, CORTLAND, NY, 130451206
|
Number of participants as of the end of the plan year
Active participants |
405 |
Retired or separated participants receiving
benefits |
7 |
Signature of
Role |
Plan administrator |
Date |
2022-07-22 |
Name of individual signing |
MARY KING |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2022-07-22 |
Name of individual signing |
MARY KING |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GUTHRIE CORTLAND MEDICAL CENTER EXCELLUS BCBS HEALTH INSURANCE PLAN
|
2021
|
150532079
|
2022-07-22
|
GUTHRIE CORTLAND MEDICAL CENTER
|
437
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1937-08-01
|
Business code |
622000
|
Sponsor’s telephone number |
6077563500
|
Plan sponsor’s mailing address |
134 HOMER AVE, CORTLAND, NY, 130451206
|
Plan sponsor’s
address |
134 HOMER AVE, CORTLAND, NY, 130451206
|
Number of participants as of the end of the plan year
Active participants |
406 |
Retired or separated participants receiving
benefits |
15 |
Signature of
Role |
Plan administrator |
Date |
2022-07-22 |
Name of individual signing |
MARY KING |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2022-07-22 |
Name of individual signing |
MARY KING |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GUTHRIE CORTLAND MEDICAL CENTER GROUP DENTAL AND VISION
|
2020
|
150532079
|
2021-10-06
|
GUTHRIE CORTLAND MEDICAL CENTER
|
539
|
|
File |
View Page
|
Three-digit plan number (PN) |
512
|
Effective date of plan |
2011-01-01
|
Business code |
622000
|
Sponsor’s telephone number |
6077563500
|
Plan
sponsor’s DBA name |
GUTHRIE CORTLAND MEDICAL CENTER
|
Plan sponsor’s mailing address |
134 HOMER AVE, CORTLAND, NY, 130451206
|
Plan sponsor’s
address |
134 HOMER AVE, CORTLAND, NY, 130451206
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2021-10-06 |
Name of individual signing |
DENISE WRINN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2021-10-06 |
Name of individual signing |
DENISE WRINN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GUTHRIE CORTLAND MEDICAL CENTER EXCELLUS BLUE CROSS BLUE SHIELD HEALTH INSURANCE PLAN
|
2020
|
150532079
|
2021-10-06
|
GUTHRIE CORTLAND MEDICAL CENTER
|
471
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1937-08-01
|
Business code |
622000
|
Sponsor’s telephone number |
6077563500
|
Plan
sponsor’s DBA name |
GUTHRIE CORTLAND MEDICAL CENTER
|
Plan sponsor’s mailing address |
134 HOMER AVE, CORTLAND, NY, 130451206
|
Plan sponsor’s
address |
134 HOMER AVE, CORTLAND, NY, 130451206
|
Number of participants as of the end of the plan year
Active participants |
443 |
Retired or separated participants receiving
benefits |
5 |
Signature of
Role |
Plan administrator |
Date |
2021-10-06 |
Name of individual signing |
DENISE WRINN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2021-10-06 |
Name of individual signing |
DENISE WRINN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GUTHRIE CORTLAND MEDICAL CENTER LIFE PLAN
|
2020
|
150532079
|
2021-10-06
|
GUTHRIE CORTLAND MEDICAL CENTER
|
625
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
1980-10-01
|
Business code |
622000
|
Sponsor’s telephone number |
6077563500
|
Plan
sponsor’s DBA name |
GUTHRIE CORTLAND MEDICAL CENTER
|
Plan sponsor’s mailing address |
134 HOMER AVE, CORTLAND, NY, 130451206
|
Plan sponsor’s
address |
134 HOMER AVE, CORTLAND, NY, 130451206
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2021-10-06 |
Name of individual signing |
DENISE WRINN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2021-10-06 |
Name of individual signing |
DENISE WRINN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GUTHRIE CORTLAND MEDICAL CENTER DISABILITY PLAN
|
2020
|
150532079
|
2021-10-06
|
GUTHRIE CORTLAND MEDICAL CENTER
|
554
|
|
File |
View Page
|
Three-digit plan number (PN) |
513
|
Effective date of plan |
2005-01-01
|
Business code |
622000
|
Sponsor’s telephone number |
6077563500
|
Plan
sponsor’s DBA name |
GUTHRIE CORTLAND MEDICAL CENTER
|
Plan sponsor’s mailing address |
134 HOMER AVE, CORTLAND, NY, 130451206
|
Plan sponsor’s
address |
134 HOMER AVE, CORTLAND, NY, 130451206
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2021-10-06 |
Name of individual signing |
DENISE WRINN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2021-10-06 |
Name of individual signing |
DENISE WRINN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GUTHRIE CORTLAND MEDICAL CENTER DENTAL/VISION PLAN
|
2019
|
150532079
|
2020-10-10
|
GUTHRIE CORTLAND MEDICAL CENTER
|
850
|
|
File |
View Page
|
Three-digit plan number (PN) |
512
|
Effective date of plan |
2011-01-01
|
Business code |
622000
|
Sponsor’s telephone number |
6077563500
|
Plan sponsor’s mailing address |
134 HOMER AVE, CORTLAND, NY, 130451206
|
Plan sponsor’s
address |
134 HOMER AVE, CORTLAND, NY, 130451206
|
Number of participants as of the end of the plan year
Active participants |
852 |
Retired or separated participants receiving
benefits |
2 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2020-10-10 |
Name of individual signing |
DENISE WRINN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2020-10-10 |
Name of individual signing |
DENISE WRINN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GUTHRIE CORTLAND MEDICAL CENTER EXCELLUS BCBS HEALTH PLAN
|
2019
|
150532079
|
2020-10-12
|
GUTHRIE CORTLAND MEDICAL CENTER
|
466
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1937-08-01
|
Business code |
622000
|
Sponsor’s telephone number |
6077563500
|
Plan sponsor’s mailing address |
134 HOMER AVE, CORTLAND, NY, 130451206
|
Plan sponsor’s
address |
134 HOMER AVENUE, CORTLAND, NY, 130451206
|
Number of participants as of the end of the plan year
Active participants |
465 |
Retired or separated participants receiving
benefits |
4 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2020-10-12 |
Name of individual signing |
DENISE WRINN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2020-10-12 |
Name of individual signing |
DENISE WRINN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GUTHRIE CORTLAND MEDICAL CENTER GROUP DISABILITY PLAN
|
2019
|
150532079
|
2020-10-10
|
GUTHRIE CORTLAND MEDICAL CENTER
|
580
|
|
File |
View Page
|
Three-digit plan number (PN) |
513
|
Effective date of plan |
2005-01-01
|
Business code |
622000
|
Sponsor’s telephone number |
6077563500
|
Plan sponsor’s mailing address |
134 HOMER AVE, CORTLAND, NY, 130451206
|
Plan sponsor’s
address |
134 HOMER AVE, CORTLAND, NY, 130451206
|
Number of participants as of the end of the plan year
Active participants |
613 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2020-10-10 |
Name of individual signing |
DENISE WRINN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2020-10-10 |
Name of individual signing |
DENISE WRINN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|