ALLENDALE ASSOCIATION MEDICAL PLAN
|
2012
|
362177140
|
2013-10-14
|
ALLENDALE ASSOCIATION
|
357
|
|
File |
View Page
|
Three-digit plan number (PN) |
504
|
Effective date of plan |
1988-01-01
|
Business code |
813000
|
Sponsor’s telephone number |
8473562351
|
Plan sponsor’s mailing address |
P.O. BOX 1088, LAKE VILLA, IL, 60046
|
Plan sponsor’s
address |
P.O. BOX 1088, LAKE VILLA, IL, 60046
|
Plan administrator’s name and address
Administrator’s EIN |
362177140 |
Plan administrator’s name |
ALLENDALE ASSOCIATION |
Plan administrator’s
address |
P.O. BOX 1088, LAKE VILLA, IL, 60046 |
Administrator’s telephone number |
8473562351 |
Number of participants as of the end of the plan year
Active participants |
342 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2013-10-14 |
Name of individual signing |
CHRISTOPHER SCHRANTZ |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
ALLENDALE ASSOCIATION SINGLE-EMPLOYER LIFE, ACCIDENTAL DEATH & DISMEMBERMENT LONG TERM DISABILITY
|
2012
|
362177140
|
2013-10-14
|
ALLENDALE ASSOCIATION
|
374
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
1989-03-01
|
Business code |
813000
|
Sponsor’s telephone number |
8473562351
|
Plan sponsor’s mailing address |
P.O. BOX 1088, LAKE VILLA, IL, 60046
|
Plan sponsor’s
address |
P.O. BOX 1088, LAKE VILLA, IL, 60046
|
Plan administrator’s name and address
Administrator’s EIN |
362177140 |
Plan administrator’s name |
ALLENDALE ASSOCIATION |
Plan administrator’s
address |
P.O. BOX 1088, LAKE VILLA, IL, 60046 |
Administrator’s telephone number |
8473562351 |
Number of participants as of the end of the plan year
Active participants |
415 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2013-10-14 |
Name of individual signing |
CHRISTOPHER SCHRANTZ |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
ALLENDALE ASSOCIATION RETIREMENT SAVINGS PLAN
|
2012
|
362177140
|
2013-10-14
|
ALLENDALE ASSOCIATION
|
450
|
|
File |
View Page
|
Three-digit plan number (PN) |
007
|
Effective date of plan |
1988-01-01
|
Business code |
813000
|
Sponsor’s telephone number |
8473562351
|
Plan sponsor’s mailing address |
P.O. BOX 1088, LAKE VILLA, IL, 60046
|
Plan sponsor’s
address |
P.O. BOX 1088, LAKE VILLA, IL, 60046
|
Plan administrator’s name and address
Administrator’s EIN |
362177140 |
Plan administrator’s name |
ALLENDALE ASSOCIATION |
Plan administrator’s
address |
P.O. BOX 1088, LAKE VILLA, IL, 60046 |
Administrator’s telephone number |
8473562351 |
Number of participants as of the end of the plan year
Active participants |
455 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
13 |
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 |
330 |
Number of participants that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
37 |
Signature of
Role |
Plan administrator |
Date |
2013-10-14 |
Name of individual signing |
CHRISTOPHER SCHRANTZ |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
EMPLOYEE BENEFITS PLAN OF ALLENDALE ASSOCIATION
|
2012
|
362177140
|
2013-10-14
|
ALLENDALE ASSOCIATION
|
372
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1983-11-01
|
Business code |
813000
|
Sponsor’s telephone number |
8473562351
|
Plan sponsor’s mailing address |
P.O. BOX 1088, LAKE VILLA, IL, 60046
|
Plan sponsor’s
address |
P.O. BOX 1088, LAKE VILLA, IL, 60046
|
Plan administrator’s name and address
Administrator’s EIN |
362177140 |
Plan administrator’s name |
ALLENDALE ASSOCIATION |
Plan administrator’s
address |
P.O. BOX 1088, LAKE VILLA, IL, 60046 |
Administrator’s telephone number |
8473562351 |
Number of participants as of the end of the plan year
Active participants |
0 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
355 |
Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
Number of participants that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
1 |
Signature of
Role |
Plan administrator |
Date |
2013-10-14 |
Name of individual signing |
CHRISTOPHER SCHRANTZ |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
ALLENDALE ASSOCIATION MEDICAL PLAN
|
2011
|
362177140
|
2012-10-12
|
ALLENDALE ASSOCIATION
|
343
|
|
File |
View Page
|
Three-digit plan number (PN) |
504
|
Effective date of plan |
1988-01-01
|
Business code |
813000
|
Sponsor’s telephone number |
8473562351
|
Plan sponsor’s mailing address |
P.O. BOX 1088, LAKE VILLA, IL, 60046
|
Plan sponsor’s
address |
P.O. BOX 1088, LAKE VILLA, IL, 60046
|
Plan administrator’s name and address
Administrator’s EIN |
362177140 |
Plan administrator’s name |
ALLENDALE ASSOCIATION |
Plan administrator’s
address |
P.O. BOX 1088, LAKE VILLA, IL, 60046 |
Administrator’s telephone number |
8473562351 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2012-10-12 |
Name of individual signing |
CHRISTOPHER SCHRANTZ |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2012-10-12 |
Name of individual signing |
CHRISTOPHER SCHRANTZ |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
ALLENDALE ASSOCIATION SINGLE-EMPLOYER LIFE, ACCIDENTAL DEATH & DISMEMBERMENT LONG TERM DISABILITY
|
2011
|
362177140
|
2012-10-12
|
ALLENDALE ASSOCIATION
|
381
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
1989-03-01
|
Business code |
813000
|
Sponsor’s telephone number |
8473562351
|
Plan sponsor’s mailing address |
P.O. BOX 1088, LAKE VILLA, IL, 60046
|
Plan sponsor’s
address |
P.O. BOX 1088, LAKE VILLA, IL, 60046
|
Plan administrator’s name and address
Administrator’s EIN |
362177140 |
Plan administrator’s name |
ALLENDALE ASSOCIATION |
Plan administrator’s
address |
P.O. BOX 1088, LAKE VILLA, IL, 60046 |
Administrator’s telephone number |
8473562351 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2012-10-12 |
Name of individual signing |
CHRISTOPHER SCHRANTZ |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2012-10-12 |
Name of individual signing |
CHRISTOPHER SCHRANTZ |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
EMPLOYEE BENEFITS PLAN OF ALLENDALE ASSOCIATION
|
2011
|
362177140
|
2012-10-12
|
ALLENDALE ASSOCIATION
|
379
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1983-11-01
|
Business code |
813000
|
Sponsor’s telephone number |
8473562351
|
Plan sponsor’s mailing address |
P.O. BOX 1088, LAKE VILLA, IL, 60046
|
Plan sponsor’s
address |
P.O. BOX 1088, LAKE VILLA, IL, 60046
|
Plan administrator’s name and address
Administrator’s EIN |
362177140 |
Plan administrator’s name |
ALLENDALE ASSOCIATION |
Plan administrator’s
address |
P.O. BOX 1088, LAKE VILLA, IL, 60046 |
Administrator’s telephone number |
8473562351 |
Number of participants as of the end of the plan year
Other
retired or separated participants entitled to future benefits |
372 |
Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2012-10-12 |
Name of individual signing |
CHRISTOPHER SCHRANTZ |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2012-10-12 |
Name of individual signing |
CHRISTOPHER SCHRANTZ |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
ALLENDALE ASSOCIATION RETIREMENT SAVINGS PLAN
|
2011
|
362177140
|
2012-10-12
|
ALLENDALE ASSOCIATION
|
446
|
|
File |
View Page
|
Three-digit plan number (PN) |
007
|
Effective date of plan |
1988-01-01
|
Business code |
813000
|
Sponsor’s telephone number |
8473562351
|
Plan sponsor’s mailing address |
P.O. BOX 1088, LAKE VILLA, IL, 60046
|
Plan sponsor’s
address |
P.O. BOX 1088, LAKE VILLA, IL, 60046
|
Plan administrator’s name and address
Administrator’s EIN |
362177140 |
Plan administrator’s name |
ALLENDALE ASSOCIATION |
Plan administrator’s
address |
P.O. BOX 1088, LAKE VILLA, IL, 60046 |
Administrator’s telephone number |
8473562351 |
Number of participants as of the end of the plan year
Active participants |
434 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
21 |
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 |
304 |
Number of participants that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
20 |
Signature of
Role |
Plan administrator |
Date |
2012-10-12 |
Name of individual signing |
CHRISTOPHER SCHRANTZ |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2012-10-12 |
Name of individual signing |
CHRISTOPHER SCHRANTZ |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
EMPLOYEE BENEFITS PLAN OF ALLENDALE ASSOCIATION
|
2010
|
362177140
|
2011-10-14
|
ALLENDALE ASSOCIATION
|
389
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1983-11-01
|
Business code |
813000
|
Sponsor’s telephone number |
8473562351
|
Plan sponsor’s mailing address |
P.O. BOX 1088, LAKE VILLA, IL, 60046
|
Plan sponsor’s
address |
P.O. BOX 1088, LAKE VILLA, IL, 60046
|
Plan administrator’s name and address
Administrator’s EIN |
362177140 |
Plan administrator’s name |
ALLENDALE ASSOCIATION |
Plan administrator’s
address |
P.O. BOX 1088, LAKE VILLA, IL, 60046 |
Administrator’s telephone number |
8473562351 |
Number of participants as of the end of the plan year
Other
retired or separated participants entitled to future benefits |
378 |
Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
1 |
Signature of
Role |
Plan administrator |
Date |
2011-10-14 |
Name of individual signing |
CHRISTOPHER SCHRANTZ |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2011-10-14 |
Name of individual signing |
CHRISTOPHER SCHRANTZ |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
ALLENDALE ASSOCIATION MEDICAL PLAN
|
2010
|
362177140
|
2011-10-14
|
ALLENDALE ASSOCIATION
|
355
|
|
File |
View Page
|
Three-digit plan number (PN) |
504
|
Effective date of plan |
1988-01-01
|
Business code |
813000
|
Sponsor’s telephone number |
8473562351
|
Plan sponsor’s mailing address |
P.O. BOX 1088, LAKE VILLA, IL, 60046
|
Plan sponsor’s
address |
P.O. BOX 1088, LAKE VILLA, IL, 60046
|
Plan administrator’s name and address
Administrator’s EIN |
362177140 |
Plan administrator’s name |
ALLENDALE ASSOCIATION |
Plan administrator’s
address |
P.O. BOX 1088, LAKE VILLA, IL, 60046 |
Administrator’s telephone number |
8473562351 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2011-10-14 |
Name of individual signing |
CHRISTOPHER SCHRANTZ |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2011-10-14 |
Name of individual signing |
CHRISTOPHER SCHRANTZ |
Valid signature |
Filed with authorized/valid electronic signature |
|
|