LAMBS FARM GROUP HEALTH PLAN
|
2018
|
362474251
|
2020-07-24
|
THE LAMBS FARM
|
176
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2018-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
8473624636
|
Plan sponsor’s mailing address |
PO BOX 520, LIBERTYVILLE, IL, 600480520
|
Plan sponsor’s
address |
14245 W. ROCKLAND ROAD, LIBERTYVILLE, IL, 60048
|
Number of participants as of the end of the plan year
Active participants |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2020-07-24 |
Name of individual signing |
CINDY GOLDENBERG |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2020-07-24 |
Name of individual signing |
CINDY GOLDENBERG |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LAMBS FARM DENTAL PLAN
|
2018
|
362474251
|
2020-07-24
|
THE LAMBS FARM
|
174
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2018-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
8473624636
|
Plan sponsor’s mailing address |
PO BOX 520, LIBERTYVILLE, IL, 600480520
|
Plan sponsor’s
address |
14245 W, ROCKLAND ROAD, LIBERTYVILLE, IL, 60048
|
Number of participants as of the end of the plan year
Active participants |
0 |
Retired or separated participants receiving
benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2020-07-24 |
Name of individual signing |
CINDY GOLDENBERG |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2020-07-24 |
Name of individual signing |
CINDY GOLDENBERG |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LAMBS FARM BASIC LIFE AND ANCILARY PLANS
|
2018
|
362474251
|
2020-07-24
|
THE LAMBS FARM
|
174
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
2018-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
8473624636
|
Plan sponsor’s mailing address |
PO BOX 520, LIBERTYVILLE, IL, 600480520
|
Plan sponsor’s
address |
14245 W. ROCKLAND ROAD, LIBERTYVILLE, IL, 60048
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2020-07-24 |
Name of individual signing |
CINDY GOLDENBERG |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2020-07-24 |
Name of individual signing |
CINDY GOLDENBERG |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LAMBS FARM GROUP HEALTH PLAN
|
2018
|
362474251
|
2019-07-24
|
THE LAMBS FARM
|
176
|
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2018-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
8473624636
|
Plan sponsor’s mailing address |
PO BOX 520, LIBERTYVILLE, IL, 600480520
|
Plan sponsor’s
address |
14245 W. ROCKLAND ROAD, LIBERTYVILLE, IL, 60048
|
Number of participants as of the end of the plan year
Active participants |
174 |
Other
retired or separated participants entitled to future benefits |
2 |
Signature of
Role |
Plan administrator |
Date |
2019-07-23 |
Name of individual signing |
CINDY GOLDENBERG |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2019-07-23 |
Name of individual signing |
CINDY GOLDENBERG |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LAMBS FARM DENTAL PLAN
|
2018
|
362474251
|
2019-07-24
|
THE LAMBS FARM
|
174
|
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2018-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
8473624636
|
Plan sponsor’s mailing address |
PO BOX 520, LIBERTYVILLE, IL, 600480520
|
Plan sponsor’s
address |
14245 W, ROCKLAND ROAD, LIBERTYVILLE, IL, 60048
|
Number of participants as of the end of the plan year
Active participants |
97 |
Retired or separated participants receiving
benefits |
2 |
Signature of
Role |
Plan administrator |
Date |
2019-07-23 |
Name of individual signing |
CINDY GOLDENBERG |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LAMBS FARM BASIC LIFE AND ANCILARY PLANS
|
2018
|
362474251
|
2019-07-24
|
THE LAMBS FARM
|
174
|
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
2018-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
8473624636
|
Plan sponsor’s mailing address |
PO BOX 520, LIBERTYVILLE, IL, 600480520
|
Plan sponsor’s
address |
14245 W. ROCKLAND ROAD, LIBERTYVILLE, IL, 60048
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2019-07-24 |
Name of individual signing |
CINDY GOLDENBERG |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LAMBS FARM LIFE INSURANCE & ANCILLARY PLANS
|
2017
|
362474251
|
2018-07-17
|
THE LAMBS FARM
|
179
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
2017-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
8473624636
|
Plan sponsor’s mailing address |
PO BOX 520, LIBERTYVILLE, IL, 600480520
|
Plan sponsor’s
address |
14245 W. ROCKLAND RD., LIBERTYVILLE, IL, 60048
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2018-07-17 |
Name of individual signing |
CINDY GOLDENBERG |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LAMBS FARM GROUP DENTAL PLAN
|
2017
|
362474251
|
2018-07-17
|
THE LAMBS FARM
|
109
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2017-01-01
|
Business code |
623000
|
Plan sponsor’s mailing address |
PO BOX 520, LIBERTYVILLE, IL, 600480520
|
Plan sponsor’s
address |
14245 W. ROCKLAND RD., LIBERTYVILLE, IL, 60048
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2018-07-17 |
Name of individual signing |
CINDY GOLDENBERG |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LAMBS FARM GROUP HEALTH PLAN
|
2017
|
362474251
|
2018-07-17
|
THE LAMBS FARM
|
181
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2017-01-01
|
Business code |
623000
|
Plan sponsor’s mailing address |
PO BOX 520, LIBERTYVILLE, IL, 600480520
|
Plan sponsor’s
address |
14245 W. ROCKLAND RD., LIBERTYVILLE, IL, 60048
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2018-07-17 |
Name of individual signing |
CINDY GOLDENBERG |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LAMBS FARM TERM LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT
|
2016
|
362474251
|
2017-07-13
|
LAMBS FARM
|
204
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
2016-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
8473624636
|
Plan sponsor’s mailing address |
PO BOX 520, LIBERTYVILLE, IL, 600480520
|
Plan sponsor’s
address |
14245 W. ROCKLAND RD., LIBERTYVILLE, IL, 60048
|
Number of participants as of the end of the plan year
Active participants |
204 |
Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
2 |
Signature of
Role |
Plan administrator |
Date |
2017-07-13 |
Name of individual signing |
CINDY GOLDENBERG |
Valid signature |
Filed with authorized/valid electronic signature |
|
|