SEMBLEX CORPORATION LIFE BENEFIT PLAN
|
2017
|
362664176
|
2018-10-11
|
SEMBLEX CORPORATION
|
232
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
1984-01-01
|
Business code |
332700
|
Sponsor’s telephone number |
6308332880
|
Plan sponsor’s mailing address |
900 N CHURCH RD, ELMHURST, IL, 601261014
|
Plan sponsor’s
address |
900 N CHURCH RD, ELMHURST, IL, 601261014
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2018-10-11 |
Name of individual signing |
GORDON MCLEISH |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-10-11 |
Name of individual signing |
GORDON MCLEISH |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
SEMBLEX CORPORATION MEDICAL DENTAL & FRINGE BENEFIT PLAN
|
2017
|
362664176
|
2018-10-11
|
SEMBLEX CORPORATION
|
210
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1984-01-01
|
Business code |
332700
|
Sponsor’s telephone number |
6308332880
|
Plan sponsor’s mailing address |
900 N CHURCH RD, ELMHURST, IL, 601261014
|
Plan sponsor’s
address |
900 N CHURCH RD, ELMHURST, IL, 601261014
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2018-10-11 |
Name of individual signing |
GORDON MCLEISH |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-10-11 |
Name of individual signing |
GORDON MCLEISH |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
SEMBLEX CORPORATION LIFE BENEFIT PLAN
|
2016
|
362664176
|
2018-10-11
|
SEMBLEX CORPORATION
|
230
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
1984-01-01
|
Business code |
332700
|
Sponsor’s telephone number |
6308332880
|
Plan sponsor’s mailing address |
900 N CHURCH RD, ELMHURST, IL, 601261014
|
Plan sponsor’s
address |
900 N CHURCH RD, ELMHURST, IL, 601261014
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2017-10-11 |
Name of individual signing |
GORDON MCLEISH |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
SEMBLEX CORPORATION MEDICAL DENTAL & FRINGE BENEFIT PLAN
|
2016
|
362664176
|
2018-10-11
|
SEMBLEX CORPORATION
|
200
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1984-01-01
|
Business code |
332700
|
Sponsor’s telephone number |
6308332880
|
Plan sponsor’s mailing address |
900 N CHURCH RD, ELMHURST, IL, 601261014
|
Plan sponsor’s
address |
900 N CHURCH RD, ELMHURST, IL, 601261014
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2017-10-11 |
Name of individual signing |
GORDON MCLEISH |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
SEMBLEX CORPORATION LIFE BENEFIT PLAN
|
2015
|
362664176
|
2016-10-10
|
SEMBLEX CORPORATION
|
230
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
1984-01-01
|
Business code |
332700
|
Sponsor’s telephone number |
6308332880
|
Plan sponsor’s mailing address |
900 N CHURCH RD, ELMHURST, IL, 601261014
|
Plan sponsor’s
address |
900 N CHURCH RD, ELMHURST, IL, 601261014
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2016-10-10 |
Name of individual signing |
GORDON MCLEISH |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
SEMBLEX COPPORATION MEDICAL DENTAL & FRINGE BENEFIT PLAN
|
2015
|
362664176
|
2016-10-10
|
SEMBLEX CORPORATION
|
220
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1984-01-01
|
Business code |
332700
|
Sponsor’s telephone number |
6308332880
|
Plan sponsor’s mailing address |
900 N CHURCH RD, ELMHURST, IL, 601261014
|
Plan sponsor’s
address |
900 N CHURCH RD, ELMHURST, IL, 601261014
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2016-10-10 |
Name of individual signing |
GORDON MCLEISH |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
SEMBLEX CORPORATION MEDICAL DENTAL & FRINGE BENEFIT PLAN
|
2014
|
362664176
|
2015-10-13
|
SEMBLEX CORPORATION
|
205
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1984-01-01
|
Business code |
332700
|
Sponsor’s telephone number |
6308332880
|
Plan sponsor’s mailing address |
600 N CHURCH RD, ELMHURST, IL, 60126
|
Plan sponsor’s
address |
600 N CHURCH RD, ELMHURST, IL, 60126
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2015-10-12 |
Name of individual signing |
GORDON MCLEISH |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2015-10-12 |
Name of individual signing |
GORDON MCLEISH |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
SEMBLEX CORPORATION LIFE BENEFIT PLAN
|
2014
|
362664176
|
2015-10-13
|
SEMBLEX CORPORATION
|
207
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
1984-01-01
|
Business code |
332700
|
Sponsor’s telephone number |
6308332880
|
Plan sponsor’s mailing address |
900 N CHURCH RD, ELMHURST, IL, 60126
|
Plan sponsor’s
address |
900 N CHURCH RD, ELMHURST, IL, 60126
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2015-10-13 |
Name of individual signing |
GORDON MCLEISH |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2015-10-13 |
Name of individual signing |
GORDON MCLEISH |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
SEMBLEX CORPORATION LIFE BENEFIT PLAN
|
2013
|
362664176
|
2014-10-14
|
SEMBLEX CORPORATION
|
200
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
1984-01-01
|
Business code |
332700
|
Sponsor’s telephone number |
6308332880
|
Plan sponsor’s mailing address |
199 W. DIVERSEY AVE, ELMHURST, IL, 60126
|
Plan sponsor’s
address |
199 W. DIVERSEY AVE, ELMHURST, IL, 60126
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2014-10-14 |
Name of individual signing |
GORDON MCLEISH |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2014-10-14 |
Name of individual signing |
GORDON MCLEISH |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
SEMBLEX CORPORATION MEDICAL DENTAL & FRINGE BENEFIT PLAN
|
2013
|
362664176
|
2014-10-14
|
SEMBLEX CORPORATION
|
195
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1984-01-01
|
Business code |
332700
|
Sponsor’s telephone number |
6308332880
|
Plan sponsor’s mailing address |
199 W. DIVERSEY AVE, ELMHURST, IL, 60126
|
Plan sponsor’s
address |
199 W. DIVERSEY AVE, ELMHURST, IL, 60126
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2014-10-14 |
Name of individual signing |
GORDON MCLEISH |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2014-10-14 |
Name of individual signing |
GORDON MCLEISH |
Valid signature |
Filed with authorized/valid electronic signature |
|
|