FIXED AND VARIABLE TAX DEFERRED ANNUITY - VOLUNTARY
|
2012
|
370661199
|
2013-10-14
|
DECATUR MEMORIAL HOSPITAL
|
44
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
1966-10-10
|
Business code |
622000
|
Sponsor’s telephone number |
2178766101
|
Plan sponsor’s
address |
2300 NORTH EDWWARD STREET, DECATUR, IL, 62526
|
Plan administrator’s name and address
Administrator’s EIN |
370661199 |
Plan administrator’s name |
DECATUR MEMORIAL HOSPITAL |
Plan administrator’s
address |
2300 NORTH EDWWARD STREET, DECATUR, IL, 62526 |
Administrator’s telephone number |
2178766101 |
Signature of
Role |
Plan administrator |
Date |
2013-10-14 |
Name of individual signing |
KEVIN HORATH |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
FIXED TAX DEFERRED ANNUITY - VOLUNTARY PLAN
|
2011
|
370661199
|
2013-04-02
|
DECATUR MEMORIAL HOSPITAL
|
30
|
|
File |
View Page
|
Three-digit plan number (PN) |
003
|
Effective date of plan |
1965-09-01
|
Business code |
622000
|
Sponsor’s telephone number |
2178766101
|
Plan sponsor’s
address |
2300 NORTH EDWARD STREET, DECATUR, IL, 62526
|
Plan administrator’s name and address
Administrator’s EIN |
370661199 |
Plan administrator’s name |
DECATUR MEMORIAL HOSPITAL |
Plan administrator’s
address |
2300 NORTH EDWARD STREET, DECATUR, IL, 62526 |
Administrator’s telephone number |
2178766101 |
Signature of
Role |
Plan administrator |
Date |
2013-04-02 |
Name of individual signing |
DEBORAH BRAGG |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
FIXED TAX DEFERRED ANNUITY - VOLUNTARY PLAN
|
2011
|
370661199
|
2013-04-02
|
DECATUR MEMORIAL HOSPITAL
|
5
|
|
File |
View Page
|
Three-digit plan number (PN) |
007
|
Effective date of plan |
1992-01-01
|
Business code |
622000
|
Sponsor’s telephone number |
2178766101
|
Plan sponsor’s
address |
2300 NORTH EDWARD STREET, DECATUR, IL, 62526
|
Plan administrator’s name and address
Administrator’s EIN |
370661199 |
Plan administrator’s name |
DECATUR MEMORIAL HOSPITAL |
Plan administrator’s
address |
2300 NORTH EDWARD STREET, DECATUR, IL, 62526 |
Administrator’s telephone number |
2178766101 |
Signature of
Role |
Plan administrator |
Date |
2013-04-02 |
Name of individual signing |
DEBORAH BRAGG |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
FIXED AND VARIABLE TAX DEFERRED ANNUITY - VOLUNTARY
|
2011
|
370661199
|
2012-10-15
|
DECATUR MEMORIAL HOSPITAL
|
56
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
1966-10-10
|
Business code |
622000
|
Sponsor’s telephone number |
2178766101
|
Plan sponsor’s
address |
2300 NORTH EDWWARD STREET, DECATUR, IL, 62526
|
Plan administrator’s name and address
Administrator’s EIN |
370661199 |
Plan administrator’s name |
DECATUR MEMORIAL HOSPITAL |
Plan administrator’s
address |
2300 NORTH EDWWARD STREET, DECATUR, IL, 62526 |
Administrator’s telephone number |
2178766101 |
Signature of
Role |
Plan administrator |
Date |
2012-10-15 |
Name of individual signing |
DEBORAH BRAGG |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
VARIABLE TAX DEFERRED ANNUITY - VOLUNTARY
|
2011
|
370661199
|
2012-10-12
|
DECATUR MEMORIAL HOSPITAL
|
1
|
|
File |
View Page
|
Three-digit plan number (PN) |
008
|
Effective date of plan |
1992-01-01
|
Business code |
622000
|
Sponsor’s telephone number |
2178766101
|
Plan sponsor’s
address |
2300 NORTH EDWARD STREET, DECATUR, IL, 62526
|
Plan administrator’s name and address
Administrator’s EIN |
370661199 |
Plan administrator’s name |
DECATUR MEMORIAL HOSPITAL |
Plan administrator’s
address |
2300 NORTH EDWARD STREET, DECATUR, IL, 62526 |
Administrator’s telephone number |
2178766101 |
Signature of
Role |
Plan administrator |
Date |
2012-10-12 |
Name of individual signing |
DEBORAH BRAGG |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
FIXED TAX DEFERRED ANNUITY PLAN
|
2011
|
370661199
|
2012-10-12
|
DECATUR MEMORIAL HOSPITAL
|
32
|
|
File |
View Page
|
Three-digit plan number (PN) |
005
|
Effective date of plan |
1988-02-25
|
Business code |
622000
|
Sponsor’s telephone number |
2178766101
|
Plan sponsor’s
address |
2300 NORTH EDWARD STREET, DECATUR, IL, 62526
|
Plan administrator’s name and address
Administrator’s EIN |
370661199 |
Plan administrator’s name |
DECATUR MEMORIAL HOSPITAL |
Plan administrator’s
address |
2300 NORTH EDWARD STREET, DECATUR, IL, 62526 |
Administrator’s telephone number |
2178766101 |
Signature of
Role |
Plan administrator |
Date |
2012-10-12 |
Name of individual signing |
DEBORAH BRAGG |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
FIXED TAX DEFERRED ANNUITY PLAN
|
2010
|
370661199
|
2013-03-11
|
DECATUR MEMORIAL HOSPITAL
|
32
|
|
File |
View Page
|
Three-digit plan number (PN) |
005
|
Effective date of plan |
1988-02-25
|
Business code |
622000
|
Sponsor’s telephone number |
2178766101
|
Plan sponsor’s
address |
2300 NORTH EDWARD STREET, DECATUR, IL, 62526
|
Plan administrator’s name and address
Administrator’s EIN |
370661199 |
Plan administrator’s name |
DECATUR MEMORIAL HOSPITAL |
Plan administrator’s
address |
2300 NORTH EDWARD STREET, DECATUR, IL, 62526 |
Administrator’s telephone number |
2178766101 |
Signature of
Role |
Plan administrator |
Date |
2013-03-11 |
Name of individual signing |
DEBORAH BRAGG |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
FIXED TAX DEFERRED ANNUITY - VOLUNTARY PLAN
|
2010
|
370661199
|
2013-03-11
|
DECATUR MEMORIAL HOSPITAL
|
8
|
|
File |
View Page
|
Three-digit plan number (PN) |
007
|
Effective date of plan |
1992-01-01
|
Business code |
622000
|
Sponsor’s telephone number |
2178766101
|
Plan sponsor’s
address |
2300 NORTH EDWARD STREET, DECATUR, IL, 62526
|
Plan administrator’s name and address
Administrator’s EIN |
370661199 |
Plan administrator’s name |
DECATUR MEMORIAL HOSPITAL |
Plan administrator’s
address |
2300 NORTH EDWARD STREET, DECATUR, IL, 62526 |
Administrator’s telephone number |
2178766101 |
Signature of
Role |
Plan administrator |
Date |
2013-03-11 |
Name of individual signing |
DEBORAH BRAGG |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
FIXED TAX DEFERRED ANNUITY PLAN
|
2010
|
370661199
|
2011-10-11
|
DECATUR MEMORIAL HOSPITAL
|
32
|
|
Three-digit plan number (PN) |
005
|
Effective date of plan |
1988-02-25
|
Business code |
622000
|
Sponsor’s telephone number |
2178766101
|
Plan sponsor’s
address |
2300 NORTH EDWARD STREET, DECATUR, IL, 62526
|
Plan administrator’s name and address
Administrator’s EIN |
370661199 |
Plan administrator’s name |
DECATUR MEMORIAL HOSPITAL |
Plan administrator’s
address |
2300 NORTH EDWARD STREET, DECATUR, IL, 62526 |
Administrator’s telephone number |
2178766101 |
Signature of
Role |
Plan administrator |
Date |
2011-10-11 |
Name of individual signing |
GARY PEACOCK |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
FIXED TAX DEFERRED ANNUITY - VOLUNTARY PLAN
|
2010
|
370661199
|
2013-03-11
|
DECATUR MEMORIAL HOSPITAL
|
31
|
|
File |
View Page
|
Three-digit plan number (PN) |
003
|
Effective date of plan |
1965-09-01
|
Business code |
622000
|
Sponsor’s telephone number |
2178766101
|
Plan sponsor’s
address |
2300 NORTH EDWARD STREET, DECATUR, IL, 62526
|
Plan administrator’s name and address
Administrator’s EIN |
370661199 |
Plan administrator’s name |
DECATUR MEMORIAL HOSPITAL |
Plan administrator’s
address |
2300 NORTH EDWARD STREET, DECATUR, IL, 62526 |
Administrator’s telephone number |
2178766101 |
Signature of
Role |
Plan administrator |
Date |
2013-03-11 |
Name of individual signing |
DEBORAH BRAGG |
Valid signature |
Filed with authorized/valid electronic signature |
|
|