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| Company Name: | SAND CREEK EAP |
| Employer identification number (EIN): | 411776426 |
| National Association of Insurance Commissioner's ID: | 00000 |
| NAIC Classification: | 00000 |
| UPPER MIDWEST ORGAN PROCUREMENT ORGANIZATION INC. DBA LIFESO | LIFESOURCE WELFARE BENEFIT PLAN | 2015-01-01 |