MEDINA MANOR'S 401(K) RETIREMENT PLAN
|
2012
|
362887017
|
2013-06-28
|
MEDINA NURSING CENTER, INC.
|
78
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1994-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
8152482151
|
Plan sponsor’s
address |
402 SOUTH CENTER STREET, DURAND, IL, 61024
|
Signature of
Role |
Plan administrator |
Date |
2013-06-28 |
Name of individual signing |
HOLGEIR OKSNEVAD |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-06-28 |
Name of individual signing |
HOLGEIR OKSNEVAD |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
MEDINA MANOR'S 401(K) RETIREMENT PLAN
|
2011
|
362887017
|
2012-08-10
|
MEDINA NURSING CENTER, INC.
|
73
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1994-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
8152482151
|
Plan sponsor’s
address |
402 SOUTH CENTER STREET, DURAND, IL, 61024
|
Plan administrator’s name and address
Administrator’s EIN |
362887017 |
Plan administrator’s name |
MEDINA NURSING CENTER, INC. |
Plan administrator’s
address |
402 SOUTH CENTER STREET, DURAND, IL, 61024 |
Administrator’s telephone number |
8152482151 |
Signature of
Role |
Plan administrator |
Date |
2012-08-10 |
Name of individual signing |
HOLGEIR OKSNEVAD |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2012-08-10 |
Name of individual signing |
HOLGEIR OKSNEVAD |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
MEDINA MANOR'S 401(K) RETIREMENT PLAN
|
2010
|
362887017
|
2011-07-25
|
MEDINA NURSING CENTER, INC.
|
65
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1994-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
8152482151
|
Plan sponsor’s
address |
402 SOUTH CENTER STREET, DURAND, IL, 61024
|
Plan administrator’s name and address
Administrator’s EIN |
362887017 |
Plan administrator’s name |
MEDINA NURSING CENTER, INC. |
Plan administrator’s
address |
402 SOUTH CENTER STREET, DURAND, IL, 61024 |
Administrator’s telephone number |
8152482151 |
Signature of
Role |
Plan administrator |
Date |
2011-07-25 |
Name of individual signing |
HOLGEIR OKSNEVAD |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2011-07-25 |
Name of individual signing |
HOLGEIR OKSNEVAD |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
MEDINA MANOR'S 401(K) RETIREMENT PLAN
|
2009
|
362887017
|
2010-10-14
|
MEDINA NURSING CENTER, INC.
|
56
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1994-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
8152482151
|
Plan sponsor’s
address |
402 SOUTH CENTER STREET, DURAND, IL, 61024
|
Plan administrator’s name and address
Administrator’s EIN |
362887017 |
Plan administrator’s name |
MEDINA NURSING CENTER, INC. |
Plan administrator’s
address |
402 SOUTH CENTER STREET, DURAND, IL, 61024 |
Administrator’s telephone number |
8152482151 |
Signature of
Role |
Plan administrator |
Date |
2010-10-13 |
Name of individual signing |
LAURA WAINWRIGHT |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2010-10-13 |
Name of individual signing |
LAURA WAINWRIGHT |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
MEDINA MANOR'S 401(K) RETIREMENT PLAN
|
2009
|
362887017
|
2010-10-12
|
MEDINA NURSING CENTER, INC.
|
56
|
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1994-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
8152482151
|
Plan sponsor’s
address |
402 SOUTH CENTER STREET, DURAND, IL, 61024
|
Plan administrator’s name and address
Administrator’s EIN |
362887017 |
Plan administrator’s name |
MEDINA NURSING CENTER, INC. |
Plan administrator’s
address |
402 SOUTH CENTER STREET, DURAND, IL, 61024 |
Administrator’s telephone number |
8152482151 |
Signature of
Role |
Plan administrator |
Date |
2010-10-12 |
Name of individual signing |
HOLGEIR OKSNEVAD |
Valid signature |
Filed with incorrect/unrecognized electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2010-10-12 |
Name of individual signing |
HOLGEIR OKSNEVAD |
Valid signature |
Filed with incorrect/unrecognized electronic signature |
|
|
MEDINA MANOR'S 401(K) RETIREMENT PLAN
|
2009
|
362887017
|
2010-09-28
|
MEDINA NURSING CENTER, INC.
|
56
|
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1994-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
8152482151
|
Plan sponsor’s
address |
402 SOUTH CENTER STREET, DURAND, IL, 61024
|
Plan administrator’s name and address
Administrator’s EIN |
362887017 |
Plan administrator’s name |
MEDINA NURSING CENTER, INC. |
Plan administrator’s
address |
402 SOUTH CENTER STREET, DURAND, IL, 61024 |
Administrator’s telephone number |
8152482151 |
Signature of
Role |
Plan administrator |
Date |
2010-09-28 |
Name of individual signing |
HOLGEIR OKSNEVAD |
Valid signature |
Filed with incorrect/unrecognized electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2010-09-28 |
Name of individual signing |
HOLGEIR OKSNEVAD |
Valid signature |
Filed with incorrect/unrecognized electronic signature |
|
|