BLANKET TRAVEL ACCIDENT POLICY FOR HOMER ELECTRIC ASSOCIATION INC
|
2023
|
920014079
|
2024-02-28
|
HOMER ELECTRIC ASSOCIATION INC
|
137
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2023-01-01
|
Business code |
221100
|
Sponsor’s telephone number |
9072353369
|
Plan sponsor’s mailing address |
3977 LAKE ST, HOMER, AK, 996037652
|
Plan sponsor’s
address |
3977 LAKE ST, HOMER, AK, 996037652
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2024-02-28 |
Name of individual signing |
CHARLENE FLYUM |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2024-02-28 |
Name of individual signing |
CHARLENE FLYUM |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BLANKET TRAVEL ACCIDENT POLICY FOR HOMER ELECTRIC ASSOCIATION INC
|
2022
|
920014079
|
2023-10-10
|
HOMER ELECTRIC ASSOCIATION INC
|
138
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2022-01-01
|
Business code |
221100
|
Sponsor’s telephone number |
9072353369
|
Plan sponsor’s mailing address |
3977 LAKE ST, HOMER, AK, 996037652
|
Plan sponsor’s
address |
3977 LAKE ST, HOMER, AK, 996037652
|
Number of participants as of the end of the plan year
Active participants |
137 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2023-10-10 |
Name of individual signing |
CHARLENE FLYUM |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2023-10-10 |
Name of individual signing |
CHARLENE FLYUM |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BLANKET TRAVEL ACCIDENT POLICY FOR HOMER ELECTRIC ASSOCIATION INC
|
2021
|
920014079
|
2022-09-24
|
HOMER ELECTRIC ASSOCIATION INC
|
142
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2021-01-01
|
Business code |
221100
|
Sponsor’s telephone number |
9072353369
|
Plan sponsor’s mailing address |
3977 LAKE ST, HOMER, AK, 996037652
|
Plan sponsor’s
address |
3977 LAKE ST, HOMER, AK, 996037652
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2022-09-24 |
Name of individual signing |
CHARLENE FLYUM |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2022-09-24 |
Name of individual signing |
CHARLENE FLYUM |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BLANKET TRAVEL ACCIDENT POLICY FOR HOMER ELECTRIC ASSOCIATION, INC.
|
2020
|
920014079
|
2021-09-17
|
HOMER ELECTRIC ASSOCIATION, INC.
|
142
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2020-08-21
|
Business code |
221100
|
Sponsor’s telephone number |
9072353369
|
Plan sponsor’s mailing address |
3977 LAKE ST, HOMER, AK, 996037652
|
Plan sponsor’s
address |
3977 LAKE ST, HOMER, AK, 996037652
|
Number of participants as of the end of the plan year
Active participants |
141 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2021-09-17 |
Name of individual signing |
CHARLENE FLYUM |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2021-09-17 |
Name of individual signing |
CHARLENE FLYUM |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BLANKET TRAVEL ACCIDENT POLICY FOR HOMER ELECTRIC ASSOCIATION, INC.
|
2019
|
920014079
|
2020-11-04
|
HOMER ELECTRIC ASSOCIATION, INC.
|
148
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2019-08-21
|
Business code |
221100
|
Sponsor’s telephone number |
9072353369
|
Plan sponsor’s mailing address |
3977 LAKE ST, HOMER, AK, 996037652
|
Plan sponsor’s
address |
3977 LAKE ST, HOMER, AK, 996037652
|
Number of participants as of the end of the plan year
Active participants |
142 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2020-11-04 |
Name of individual signing |
CHARLENE FLYUM |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2020-11-04 |
Name of individual signing |
CHARLENE FLYUM |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BLANKET ACCIDENT INSURANCE PROGRAM FOR HOMER ELECTRIC ASSOCIATION, INC
|
2014
|
920014079
|
2015-02-09
|
HOMER ELECTRIC ASSOCIATION
|
167
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2003-08-21
|
Business code |
221100
|
Sponsor’s telephone number |
9072353369
|
Plan sponsor’s mailing address |
3977 LAKE STREET, HOMER, AK, 99603
|
Plan sponsor’s
address |
3977 LAKE STREET, HOMER, AK, 99603
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2015-01-23 |
Name of individual signing |
SHERI GOWER |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2015-01-21 |
Name of individual signing |
BETH WYTHE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BLANKET ACCIDENT INSURANCE PROGRAM FOR HOMER ELECTRIC ASSOCIATION, INC.
|
2013
|
920014079
|
2014-03-24
|
HOMER ELECTRIC ASSOCIATION, INC.
|
168
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2003-08-21
|
Business code |
221100
|
Sponsor’s telephone number |
9072353388
|
Plan sponsor’s mailing address |
3977 LAKE STREET, HOMER, AK, 99603
|
Plan sponsor’s
address |
3977 LAKE STREET, HOMER, AK, 99603
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2014-03-24 |
Name of individual signing |
PAT FERGUSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2014-03-19 |
Name of individual signing |
BETH WYTHE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BLANKET ACCIDENT INSURANCE PROGRAM FOR HOMER ELECTRIC ASSOCIATION, INC.
|
2012
|
920014079
|
2013-03-06
|
HOMER ELECTRIC ASSOCIATION INC
|
141
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2003-08-21
|
Business code |
221100
|
Sponsor’s telephone number |
9072353369
|
Plan sponsor’s mailing address |
3977 LAKE ST, HOMER, AK, 99603
|
Plan sponsor’s
address |
3977 LAKE ST, HOMER, AK, 99603
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2013-02-25 |
Name of individual signing |
BETH WYTHE |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-03-06 |
Name of individual signing |
PAT FERGUSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BLANKET ACCIDENT INSURANCE PROGRAM FOR HOMER ELECTRIC ASSOCIATION, INC.
|
2011
|
920014079
|
2012-06-12
|
HOMER ELECTRIC ASSOCIATION INC
|
144
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2003-08-21
|
Business code |
221100
|
Sponsor’s telephone number |
9072353327
|
Plan sponsor’s mailing address |
3977 LAKE ST, HOMER, AK, 99603
|
Plan sponsor’s
address |
3977 LAKE ST, HOMER, AK, 99603
|
Plan administrator’s name and address
Administrator’s EIN |
920014079 |
Plan administrator’s name |
HOMER ELECTRIC ASSOCIATION INC |
Plan administrator’s
address |
3977 LAKE ST, HOMER, AK, 99603 |
Administrator’s telephone number |
9072353327 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2012-06-12 |
Name of individual signing |
PAT FERGUSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2012-05-22 |
Name of individual signing |
BETH WYTHE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BLANKET ACCIDENT INSURANCE POLICY FOR HOMER ELECTRIC ASSOCIATION, INC.
|
2010
|
920014079
|
2011-04-08
|
HOMER ELECTRIC ASSOCIATION, INC.
|
143
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2003-08-21
|
Business code |
221100
|
Sponsor’s telephone number |
9072353327
|
Plan sponsor’s mailing address |
3977 LAKE ST, HOMER, AK, 99603
|
Plan sponsor’s
address |
3977 LAKE ST, HOMER, AK, 99603
|
Plan administrator’s name and address
Administrator’s EIN |
920014079 |
Plan administrator’s name |
HOMER ELECTRIC ASSOCIATION, INC. |
Plan administrator’s
address |
3977 LAKE ST, HOMER, AK, 99603 |
Administrator’s telephone number |
9072353327 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2011-03-31 |
Name of individual signing |
BETH WYTHE |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2011-04-06 |
Name of individual signing |
PAT FERGUSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|