WESTMINSTER VILLAGE GROUP LIFE INSURANCE POLICY
|
2018
|
371101586
|
2019-09-04
|
WESTMINSTER VILLAGE, INC.
|
171
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2017-06-01
|
Business code |
623000
|
Sponsor’s telephone number |
3096636474
|
Plan sponsor’s mailing address |
2025 E LINCOLN ST, BLOOMINGTON, IL, 617015995
|
Plan sponsor’s
address |
2025 E LINCOLN ST, BLOOMINGTON, IL, 617015995
|
Number of participants as of the end of the plan year
Active participants |
194 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2019-09-04 |
Name of individual signing |
JENNIFER HANNA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2019-09-04 |
Name of individual signing |
JENNIFER HANNA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
WESTMINSTER VILLAGE INC, DENTAL PLAN
|
2018
|
371101586
|
2019-02-01
|
WESTMINSTER VILLAGE, INC.
|
100
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2018-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
3096636474
|
Plan sponsor’s mailing address |
2025 E LINCOLN ST, BLOOMINGTON, IL, 617015995
|
Plan sponsor’s
address |
2025 E LINCOLN ST, BLOOMINGTON, IL, 617015995
|
Number of participants as of the end of the plan year
Active participants |
103 |
Retired or separated participants receiving
benefits |
1 |
Other
retired or separated participants entitled to future benefits |
0 |
Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2019-02-01 |
Name of individual signing |
JENNIFER HANNA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2019-02-01 |
Name of individual signing |
JENNIFER HANNA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
WESTMINSTER VILLAGE GROUP LIFE INSURANCE POLICY
|
2017
|
371101586
|
2018-07-19
|
WESTMINSTER VILLAGE, INC.
|
160
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2017-06-01
|
Business code |
623000
|
Sponsor’s telephone number |
3096636474
|
Plan sponsor’s mailing address |
2025 E LINCOLN ST, BLOOMINGTON, IL, 617015995
|
Plan sponsor’s
address |
2025 E LINCOLN ST, BLOOMINGTON, IL, 617015995
|
Number of participants as of the end of the plan year
Active participants |
171 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2018-07-19 |
Name of individual signing |
JENNIFER HANNA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-07-19 |
Name of individual signing |
JENNIFER HANNA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
WESTMINSTER VILLAGE, INC. GROUP LIFE INSURANCE PLAN
|
2017
|
371101586
|
2018-04-05
|
WESTMINSTER VILLAGE, INC.
|
128
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2017-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
3096636474
|
Plan sponsor’s mailing address |
2025 E LINCOLN ST, BLOOMINGTON, IL, 617015995
|
Plan sponsor’s
address |
2025 E LINCOLN ST, BLOOMINGTON, IL, 617015995
|
Number of participants as of the end of the plan year
Active participants |
132 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2018-04-05 |
Name of individual signing |
JENNIFER HANNA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-04-05 |
Name of individual signing |
JENNIFER HANNA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
WESTMINSTER VILLAGE, INC. GROUP LIFE INSURANCE PLAN
|
2016
|
371101586
|
2018-04-05
|
WESTMINSTER VILLAGE, INC.
|
120
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2016-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
3096636474
|
Plan sponsor’s mailing address |
2025 E LINCOLN ST, BLOOMINGTON, IL, 617015995
|
Plan sponsor’s
address |
2025 E LINCOLN ST, BLOOMINGTON, IL, 617015995
|
Number of participants as of the end of the plan year
Active participants |
128 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2018-04-05 |
Name of individual signing |
JENNIFER HANNA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-04-05 |
Name of individual signing |
JENNIFER HANNA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
WESTMINSTER VILLAGE, INC. LIFE INSURANCE PLAN
|
2015
|
371101586
|
2018-04-05
|
WESTMINSTER VILLAGE, INC.
|
109
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2015-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
3096636474
|
Plan sponsor’s mailing address |
2025 E LINCOLN ST, BLOOMINGTON, IL, 617015995
|
Plan sponsor’s
address |
2025 E LINCOLN ST, BLOOMINGTON, IL, 617015995
|
Number of participants as of the end of the plan year
Active participants |
119 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2018-04-05 |
Name of individual signing |
JENNIFER HANNA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-04-05 |
Name of individual signing |
JENNIFER HANNA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
WESTMINSTER VILLAGE, INC.
|
2014
|
371101586
|
2018-04-05
|
WESTMINSTER VILLAGE, INC.
|
100
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2014-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
3096636474
|
Plan sponsor’s mailing address |
2025 E LINCOLN ST, BLOOMINGTON, IL, 61701
|
Plan sponsor’s
address |
2025 E LINCOLN ST, BLOOMINGTON, IL, 61701
|
Number of participants as of the end of the plan year
Active participants |
109 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2018-04-05 |
Name of individual signing |
JENNIFER HANNA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-04-05 |
Name of individual signing |
JENNIFER HANNA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
WESTMINSTER VILLAGE LIFE INSURANCE PLAN
|
2014
|
371101586
|
2018-04-20
|
WESTMINSTER VILLAGE, INC.
|
100
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2014-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
3096636474
|
Plan
sponsor’s DBA name |
WESTMINSTER VILLAGE, INC.
|
Plan sponsor’s mailing address |
2025 E LINCOLN, BLOOMINGTON, IL, 61701
|
Plan sponsor’s
address |
2025 E LINCOLN, BLOOMINGTON, IL, 61701
|
Signature of
Role |
Plan administrator |
Date |
2018-04-20 |
Name of individual signing |
JENNIFER HANNA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-04-20 |
Name of individual signing |
JENNIFER HANNA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
WESTMINSTER VILLAGE, INC. 401(K) PLAN
|
2013
|
371101586
|
2014-02-19
|
WESTMINSTER VILLAGE, INC.
|
110
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2001-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
3096636474
|
Plan sponsor’s
address |
2025 E LINCOLN ST, BLOOMINGTON, IL, 617015995
|
Signature of
Role |
Plan administrator |
Date |
2014-02-18 |
Name of individual signing |
SHERI OLIVER |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2014-02-19 |
Name of individual signing |
SHERI OLIVER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
WESTMINSTER VILLAGE, INC. 401(K) PLAN
|
2012
|
371101586
|
2013-02-06
|
WESTMINSTER VILLAGE, INC.
|
106
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2001-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
3096636474
|
Plan sponsor’s
address |
2025 E LINCOLN ST, BLOOMINGTON, IL, 617015995
|
Signature of
Role |
Plan administrator |
Date |
2013-02-06 |
Name of individual signing |
SHERI OLIVER |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-02-06 |
Name of individual signing |
SHERI OLIVER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|