PROVENA HEALTH EMPLOYEE WELFARE PLAN
|
2012
|
363366652
|
2013-10-15
|
PROVENA HEALTH
|
8442
|
|
File |
View Page
|
Three-digit plan number (PN) |
510
|
Effective date of plan |
1999-01-01
|
Business code |
622000
|
Sponsor’s telephone number |
8158062325
|
Plan sponsor’s mailing address |
18965 HICKORY CREEK DR., SUITE 300, MOKENA, IL, 60448
|
Plan sponsor’s
address |
18965 HICKORY CREEK DR., SUITE 300, MOKENA, IL, 60448
|
Number of participants as of the end of the plan year
Active participants |
8324 |
Retired or separated participants receiving
benefits |
89 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2013-10-15 |
Name of individual signing |
MARY ANN NOLAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-10-15 |
Name of individual signing |
MARY ANN NOLAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
PROVENA HEALTH EMPLOYEE WELFARE BENEFIT PROGRAM
|
2011
|
363366652
|
2012-10-15
|
PROVENA HEALTH
|
8394
|
|
File |
View Page
|
Three-digit plan number (PN) |
510
|
Effective date of plan |
1999-01-01
|
Business code |
622000
|
Sponsor’s telephone number |
7084786342
|
Plan sponsor’s mailing address |
19065 HICKORY CREEK DRIVE, SUITE 300, MOKENA, IL, 60448
|
Plan sponsor’s
address |
19065 HICKORY CREEK DRIVE, SUITE 300, MOKENA, IL, 60448
|
Plan administrator’s name and address
Administrator’s EIN |
363366652 |
Plan administrator’s name |
PROVENA HEALTH |
Plan administrator’s
address |
19065 HICKORY CREEK DRIVE, SUITE 300, MOKENA, IL, 60448 |
Administrator’s telephone number |
7084786342 |
Number of participants as of the end of the plan year
Active participants |
8343 |
Retired or separated participants receiving
benefits |
99 |
Signature of
Role |
Plan administrator |
Date |
2012-10-15 |
Name of individual signing |
MARY ANN NOLAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
PROVENA HEALTH EMPLOYEE WELFARE BENEFIT PROGRAM
|
2010
|
363366652
|
2011-10-14
|
PROVENA HEALTH
|
8394
|
|
File |
View Page
|
Three-digit plan number (PN) |
510
|
Effective date of plan |
1999-01-01
|
Business code |
622000
|
Sponsor’s telephone number |
7084786342
|
Plan sponsor’s mailing address |
19065 HICKORY CREEK DRIVE, SUITE 300, MOKENA, IL, 60448
|
Plan sponsor’s
address |
19065 HICKORY CREEK DRIVE, SUITE 300, MOKENA, IL, 60448
|
Plan administrator’s name and address
Administrator’s EIN |
363366652 |
Plan administrator’s name |
PROVENA HEALTH |
Plan administrator’s
address |
19065 HICKORY CREEK DRIVE, MOKENA, IL, 60448 |
Administrator’s telephone number |
7084786342 |
Number of participants as of the end of the plan year
Active participants |
8403 |
Retired or separated participants receiving
benefits |
110 |
Signature of
Role |
Plan administrator |
Date |
2011-10-14 |
Name of individual signing |
MARY ANN NOLAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
PROVENA HEALTH EMPLOYEE WELFARE BENEFIT PROGRAM
|
2009
|
363366652
|
2010-10-15
|
PROVENA HEALTH
|
8394
|
|
File |
View Page
|
Three-digit plan number (PN) |
510
|
Effective date of plan |
1999-01-01
|
Business code |
622000
|
Sponsor’s telephone number |
7084786333
|
Plan sponsor’s mailing address |
19065 HICKORY CREEK DRIVE, MOKENA, IL, 60448
|
Plan sponsor’s
address |
19065 HICKORY CREEK DRIVE, MOKENA, IL, 60448
|
Plan administrator’s name and address
Administrator’s EIN |
363366652 |
Plan administrator’s name |
PROVENA HEALTH |
Plan administrator’s
address |
19065 HICKORY CREEK DRIVE, MOKENA, IL, 60448 |
Administrator’s telephone number |
7084786333 |
Number of participants as of the end of the plan year
Active participants |
8394 |
Retired or separated participants receiving
benefits |
135 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2010-10-15 |
Name of individual signing |
MARY ANN NOLAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|