HEART OF AMERICA RESTAURANTS & INNS CONSUMER DRIVEN HEALTH PLAN
|
2010
|
320052825
|
2011-04-27
|
HEART OF AMERICA MANAGEMENT L.L.C.
|
33
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2006-01-01
|
Business code |
722110
|
Sponsor’s telephone number |
3097979300
|
Plan sponsor’s mailing address |
1501 RIVER DRIVE, MOLINE, IL, 61265
|
Plan sponsor’s
address |
1501 RIVER DRIVE, MOLINE, IL, 61265
|
Plan administrator’s name and address
Administrator’s EIN |
320052825 |
Plan administrator’s name |
HEART OF AMERICA MANAGEMENT L.L.C. |
Plan administrator’s
address |
1501 RIVER DRIVE, MOLINE, IL, 61265 |
Administrator’s telephone number |
3097979300 |
Number of participants as of the end of the plan year
Active participants |
30 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
2 |
Signature of
Role |
Plan administrator |
Date |
2011-04-27 |
Name of individual signing |
CHARLES ULLRICH |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
HEART OF AMERICA RESTAURANTS & INNS HEALTH INSURANCE PLAN
|
2009
|
320052825
|
2011-04-26
|
HEART OF AMERICA MANAGEMENT L.L.C
|
131
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1998-10-01
|
Business code |
722110
|
Sponsor’s telephone number |
3097979300
|
Plan sponsor’s mailing address |
1501 RIVER DRIVE, MOLINE, IL, 61265
|
Plan sponsor’s
address |
1501 RIVER DRIVE, MOLINE, IL, 61265
|
Plan administrator’s name and address
Administrator’s EIN |
320052825 |
Plan administrator’s name |
HEART OF AMERICA MANAGEMENT L.L.C |
Plan administrator’s
address |
1501 RIVER DRIVE, MOLINE, IL, 61265 |
Administrator’s telephone number |
3097979300 |
Number of participants as of the end of the plan year
Active participants |
149 |
Retired or separated participants receiving
benefits |
1 |
Other
retired or separated participants entitled to future benefits |
5 |
Signature of
Role |
Plan administrator |
Date |
2011-04-26 |
Name of individual signing |
CHARLES ULLRICH |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
HEART OF AMERICA RESTAURANTS & INNS CONSUMER DRIVEN HEALTH PLAN
|
2009
|
320052825
|
2010-07-27
|
HEART OF AMERICA MANAGEMENT L.L.C
|
35
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2006-01-01
|
Business code |
722110
|
Sponsor’s telephone number |
3097979300
|
Plan sponsor’s mailing address |
1501 RIVER DRIVE, MOLINE, IL, 61265
|
Plan sponsor’s
address |
1501 RIVER DRIVE, MOLINE, IL, 61265
|
Plan administrator’s name and address
Administrator’s EIN |
320052825 |
Plan administrator’s name |
HEART OF AMERICA MANAGEMENT L.L.C |
Plan administrator’s
address |
1501 RIVER DRIVE, MOLINE, IL, 61265 |
Administrator’s telephone number |
3097433271 |
Number of participants as of the end of the plan year
Active participants |
33 |
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 |
2010-07-27 |
Name of individual signing |
CHARLES ULLRICH |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
HEART OF AMERICA RESTAURANTS & INNS CONSUMER DRIVEN HEALTH PLAN
|
2009
|
320052825
|
2010-07-27
|
HEART OF AMERICA MANAGEMENT L.L.C
|
35
|
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2006-01-01
|
Business code |
722110
|
Sponsor’s telephone number |
3097979300
|
Plan sponsor’s mailing address |
1501 RIVER DRIVE, MOLINE, IL, 61265
|
Plan sponsor’s
address |
1501 RIVER DRIVE, MOLINE, IL, 61265
|
Plan administrator’s name and address
Administrator’s EIN |
320052825 |
Plan administrator’s name |
HEART OF AMERICA MANAGEMENT L.L.C |
Plan administrator’s
address |
1501 RIVER DRIVE, MOLINE, IL, 61265 |
Administrator’s telephone number |
3097433271 |
Number of participants as of the end of the plan year
Active participants |
33 |
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 |
Employer/plan sponsor |
Date |
2010-07-27 |
Name of individual signing |
CHARLES ULLRICH |
Valid signature |
Filed with authorized/valid electronic signature |
|
|