CELTIC LODGINGS LLC EMPLOYEE GROUP HEALTH PLAN
|
2020
|
364457918
|
2021-03-31
|
CELTIC LODGINGS
|
6
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2020-01-01
|
Business code |
721110
|
Sponsor’s telephone number |
8157760707
|
Plan
sponsor’s DBA name |
THE IRISH COTTAGE
|
Plan sponsor’s
address |
201 S MAIN ST, GALENA, IL, 610362284
|
Signature of
Role |
Plan administrator |
Date |
2021-03-31 |
Name of individual signing |
JOHN MAZOR |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CELTIC LODGINGS LLC EMPLOYEE GROUP HEALTH PLAN
|
2019
|
364457918
|
2020-06-13
|
CELTIC LODGINGS
|
10
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2019-01-01
|
Business code |
721110
|
Plan
sponsor’s DBA name |
THE IRISH COTTAGE
|
Plan sponsor’s
address |
9853 W US HIGHWAY 20, GALENA, IL, 610369186
|
Signature of
Role |
Plan administrator |
Date |
2020-06-13 |
Name of individual signing |
JOHN MAZOR |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CELTIC LODGINGS LLC EMPLOYEE GROUP HEALTH PLAN
|
2018
|
364457918
|
2019-07-26
|
CELTIC LODGINGS
|
11
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2018-01-01
|
Business code |
721110
|
Plan
sponsor’s DBA name |
THE IRISH COTTAGE BOUTIQUE HOTEL
|
Plan sponsor’s
address |
9853 W US HIGHWAY 20, GALENA, IL, 610369186
|
Signature of
Role |
Plan administrator |
Date |
2019-07-26 |
Name of individual signing |
JOHN MAZOR |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CELTIC LODGINGS LLC EMPLYEE GROUP HEALTH PLAN
|
2017
|
364457918
|
2018-06-09
|
CELTIC LODGINGS LLC
|
13
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2017-01-01
|
Business code |
721110
|
Sponsor’s telephone number |
8157760707
|
Plan
sponsor’s DBA name |
THE IRISH COTTAGE BOUTIQUE HOTEL
|
Plan sponsor’s
address |
9853 W US HIGHWAY 20, GALENA, IL, 610369186
|
Signature of
Role |
Plan administrator |
Date |
2018-06-09 |
Name of individual signing |
JOHN MAZOR |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CELTIC LODGINGS LLC EMPLOYEE GROUP HEALTH PLAN
|
2016
|
364457918
|
2017-06-28
|
CELTIC LODGINGS LLC
|
13
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2016-01-01
|
Business code |
721110
|
Plan
sponsor’s DBA name |
IRISH COTTAGE BOUTIQUE HOTEL
|
Plan sponsor’s
address |
9853 W US HIGHWAY 20, GALENA, IL, 610369186
|
Signature of
Role |
Plan administrator |
Date |
2017-06-28 |
Name of individual signing |
JOHN MAZOR |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CELTIC LODGINGS LLC EMPLOYEE GROUP HEALTH PLAN
|
2015
|
364457918
|
2016-10-07
|
CELTIC LODGINGS LLC
|
11
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2015-04-01
|
Business code |
721110
|
Plan
sponsor’s DBA name |
THE IRISH COTTAGE BOUTIQUE HOTEL
|
Plan sponsor’s
address |
9853 W US HIGHWAY 20, GALENA, IL, 610369186
|
Signature of
Role |
Plan administrator |
Date |
2016-10-07 |
Name of individual signing |
JOHN MAZOR |
Valid signature |
Filed with authorized/valid electronic signature |
|
|