|
SHAWNEE HEALTH SERVICES GROUP HEALTH BENEFIT PLAN
|
2012
|
370966854
|
2015-01-09
|
SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORPORATION
|
244
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2012-01-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
6189569513
|
| Plan sponsor’s mailing address |
109 CALIFORNIA STREET, PO BOX 577, CARTERVILLE, IL, 629180577
|
| Plan sponsor’s
address |
109 CALIFORNIA STREET, PO BOX 577, CARTERVILLE, IL, 629180577
|
Number of participants as of the end of the plan year
| Active participants |
247 |
| Retired or separated participants receiving
benefits |
1 |
| Other
retired or separated participants entitled to future benefits |
0 |
Signature of
| Role |
Plan administrator |
| Date |
2015-01-09 |
| Name of individual signing |
JEFFREY COOPER |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2015-01-09 |
| Name of individual signing |
JEFFREY COOPER |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORPORATION 401K AND PROFIT SHARING PLAN
|
2009
|
370966854
|
2011-05-11
|
SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORPORATION
|
329
|
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
1985-07-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
6189569513
|
| Plan sponsor’s mailing address |
109 CALIFORNIA STREET, PO BOX 577, CARTERVILLE, IL, 629180577
|
| Plan sponsor’s
address |
109 CALIFORNIA STREET, PO BOX 577, CARTERVILLE, IL, 629180577
|
Plan administrator’s name and address
| Administrator’s EIN |
370966854 |
| Plan administrator’s name |
SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORPORATION |
| Plan administrator’s
address |
109 CALIFORNIA STREET, PO BOX 577, CARTERVILLE, IL, 629180577 |
| Administrator’s telephone number |
6189569513 |
Number of participants as of the end of the plan year
| Active participants |
321 |
| Retired or separated participants receiving
benefits |
0 |
| Other
retired or separated participants entitled to future benefits |
114 |
| Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
| Number of
participants
with
account balances as of the end of the plan year |
381 |
| Number of participants that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
15 |
Signature of
| Role |
Employer/plan sponsor |
| Date |
2011-05-11 |
| Name of individual signing |
PATSY JENSEN |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORPORATION 401K AND PROFIT SHARING PLAN
|
2009
|
370966854
|
2011-08-24
|
SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORPORATION
|
329
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
1985-07-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
6189569513
|
| Plan sponsor’s mailing address |
109 CALIFORNIA STREET, PO BOX 577, CARTERVILLE, IL, 629180577
|
| Plan sponsor’s
address |
109 CALIFORNIA STREET, PO BOX 577, CARTERVILLE, IL, 629180577
|
Plan administrator’s name and address
| Administrator’s EIN |
370966854 |
| Plan administrator’s name |
SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORPORATION |
| Plan administrator’s
address |
109 CALIFORNIA STREET, PO BOX 577, CARTERVILLE, IL, 629180577 |
| Administrator’s telephone number |
6189569513 |
Number of participants as of the end of the plan year
| Active participants |
321 |
| Retired or separated participants receiving
benefits |
0 |
| Other
retired or separated participants entitled to future benefits |
114 |
| Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
| Number of
participants
with
account balances as of the end of the plan year |
381 |
| Number of participants that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
15 |
Signature of
| Role |
Plan administrator |
| Date |
2011-08-24 |
| Name of individual signing |
JEFFREY COOPER |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2011-08-24 |
| Name of individual signing |
PATSY JENSEN |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORPORATION 401K AND PROFIT SHARING PLAN
|
2009
|
370966854
|
2011-04-14
|
SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORPORATION
|
329
|
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
1985-07-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
6189569513
|
| Plan sponsor’s mailing address |
109 CALIFORNIA STREET, PO BOX 577, CARTERVILLE, IL, 629180577
|
| Plan sponsor’s
address |
109 CALIFORNIA STREET, PO BOX 577, CARTERVILLE, IL, 629180577
|
Plan administrator’s name and address
| Administrator’s EIN |
370966854 |
| Plan administrator’s name |
SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORPORATION |
| Plan administrator’s
address |
109 CALIFORNIA STREET, PO BOX 577, CARTERVILLE, IL, 629180577 |
| Administrator’s telephone number |
6189569513 |
Number of participants as of the end of the plan year
| Active participants |
321 |
| Retired or separated participants receiving
benefits |
0 |
| Other
retired or separated participants entitled to future benefits |
114 |
| Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
| Number of
participants
with
account balances as of the end of the plan year |
381 |
| Number of participants that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
15 |
Signature of
| Role |
Plan administrator |
| Date |
2011-04-14 |
| Name of individual signing |
PATSY JENSEN |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
