GO SELF INSURED, LLC 401(K) PLAN
|
2015
|
272216741
|
2016-07-02
|
GO SELF INSURED, LLC
|
18
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2012-01-01
|
Business code |
524290
|
Sponsor’s telephone number |
8157622254
|
Plan sponsor’s
address |
PO BOX 468, SYCAMORE, IL, 60178
|
Signature of
Role |
Plan administrator |
Date |
2016-07-02 |
Name of individual signing |
BRAD OSBORN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GO SELF INSURED, LLC 401(K) PLAN
|
2015
|
272216741
|
2016-05-14
|
GO SELF INSURED, LLC
|
16
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2012-01-01
|
Business code |
524290
|
Sponsor’s telephone number |
8157622254
|
Plan sponsor’s
address |
PO BOX 468, SYCAMORE, IL, 60178
|
Signature of
Role |
Plan administrator |
Date |
2016-05-14 |
Name of individual signing |
BRAD OSBORN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GO SELF INSURED, LLC 401(K) PLAN
|
2014
|
272216741
|
2015-07-05
|
GO SELF INSURED, LLC
|
11
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2012-01-01
|
Business code |
524290
|
Sponsor’s telephone number |
8157622254
|
Plan sponsor’s
address |
PO BOX 468, SYCAMORE, IL, 60178
|
Signature of
Role |
Plan administrator |
Date |
2015-07-05 |
Name of individual signing |
BRAD OSBORN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GO SELF INSURED, LLC 401(K) PLAN
|
2013
|
272216741
|
2014-05-13
|
GO SELF INSURED, LLC
|
12
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2012-01-01
|
Business code |
524290
|
Sponsor’s telephone number |
8157622254
|
Plan sponsor’s
address |
PO BOX 468, 308 WEST STATE STREET, SUITE 302, SYCAMORE, IL, 60178
|
Signature of
Role |
Plan administrator |
Date |
2014-05-13 |
Name of individual signing |
BRAD OSBORN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GO SELF INSURED, LLC 401(K) PLAN
|
2012
|
272216741
|
2013-08-16
|
GO SELF INSURED, LLC
|
12
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2012-01-01
|
Business code |
524290
|
Plan sponsor’s mailing address |
6653 WEAVER ROAD, ROCKFORD, IL, 61114
|
Plan sponsor’s
address |
6653 WEAVER ROAD, ROCKFORD, IL, 61114
|
Number of participants as of the end of the plan year
Active participants |
12 |
Number of
participants
with
account balances as of the end of the plan year |
12 |
Signature of
Role |
Plan administrator |
Date |
2013-08-16 |
Name of individual signing |
SUSAN OSBORN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GO SELF INSURED, LLC 401(K) PLAN
|
2012
|
272216741
|
2013-06-10
|
GO SELF INSURED, LLC
|
12
|
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2012-01-01
|
Business code |
524290
|
Sponsor’s telephone number |
8157622254
|
Plan sponsor’s
address |
6653 WEAVER ROAD, ROCKFORD, IL, 61114
|
Signature of
Role |
Plan administrator |
Date |
2013-06-10 |
Name of individual signing |
BRAD OSBORN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|