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| Plan Name | ST CROIX HOSPICE DENTAL PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | ST. CROIX HOSPICE LLC |
| Employer identification number (EIN): | 262846682 |
| NAIC Classification: | 621610 |
| NAIC Description: | Home Health Care Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2017-01-01 | BRIAN WEGENER | |||
| 502 | 2016-01-01 | BRIAN WEGENER | |||
| 502 | 2015-01-01 | BRIAN WEGENER | BRIAN WEGENER | 2016-07-21 | |
| 502 | 2014-01-01 | BRIAN WEGENER | BRIAN WEGENER | 2015-07-30 | |
| 502 | 2013-02-01 | BRIAN WEGENER | BRIAN WEGENER | 2014-07-29 |
| DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 ) | |
| Policy contract number | 000733692 |
| Policy instance | 1 |
| DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 ) | |
| Policy contract number | 0000733692 |
| Policy instance | 1 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | KM05989131 |
| Policy instance | 1 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | KM05989131 |
| Policy instance | 1 |
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