NORTHEAST RESIDENCE INC LIFE AND LTD
|
2015
|
237309993
|
2017-06-09
|
NORTHEAST RESIDENCE INC
|
125
|
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2015-10-01
|
Business code |
623000
|
Sponsor’s telephone number |
6517650217
|
Plan sponsor’s mailing address |
410 LITTLE CANADA RD E, LITTLE CANADA, MN, 551171629
|
Plan sponsor’s
address |
410 LITTLE CANADA RD E, LITTLE CANADA, MN, 551171629
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2017-06-09 |
Name of individual signing |
MARY MILLER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
NORTHEAST RESIDENCE INC
|
2015
|
237309993
|
2017-06-09
|
NORTHEAST RESIDENCE INC
|
114
|
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
2015-10-01
|
Business code |
623000
|
Sponsor’s telephone number |
6517650217
|
Plan sponsor’s mailing address |
410 LITTLE CANADA RD E, LITTLE CANADA, MN, 551171629
|
Plan sponsor’s
address |
410 LITTLE CANADA RD E, LITTLE CANADA, MN, 551171629
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2017-06-09 |
Name of individual signing |
MARY MILLER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
NORTHEAST RESIDENCE INC HEALTH PLAM
|
2015
|
237309993
|
2016-04-28
|
NORTHEAST RESIDENCE INC
|
69
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
2015-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
6517650217
|
Plan sponsor’s mailing address |
410 LITTLE CANADA RD E, LITTLE CANADA, MN, 551171629
|
Plan sponsor’s
address |
410 LITTLE CANADA RD E, LITTLE CANADA, MN, 551171629
|
Number of participants as of the end of the plan year
Active participants |
71 |
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 |
Number of
participants
with
account balances as of the end of the plan year |
0 |
Number of participants that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
0 |
Signature of
Role |
Plan administrator |
Date |
2016-04-28 |
Name of individual signing |
NORA COGNETTA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2016-04-28 |
Name of individual signing |
NORA COGNETTA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
NORTHEAST RESIDENCE INC LIFE AD&D AND LTD PLAN
|
2014
|
237309993
|
2015-12-23
|
NORTHEAST RESIDENCE INC.
|
113
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
1999-10-01
|
Business code |
623000
|
Sponsor’s telephone number |
6517650217
|
Plan sponsor’s mailing address |
410 E LITTLE CANADA ROAD, LITTLE CANADA, MN, 55117
|
Plan sponsor’s
address |
410 E LITTLE CANADA ROAD, LITTLE CANADA, MN, 55117
|
Number of participants as of the end of the plan year
Active participants |
125 |
Retired or separated participants receiving
benefits |
2 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2015-12-23 |
Name of individual signing |
NORA COGNETTA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
NORTHEAST RESIDENCE INC DENTAL PLAN
|
2014
|
237309993
|
2015-12-07
|
NORTHEAST RESIDENCE INC
|
104
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1999-10-01
|
Business code |
623000
|
Sponsor’s telephone number |
6517650217
|
Plan sponsor’s mailing address |
410 EAST LITTLE CANADA ROAD, LITTLE CANADA, MN, 55117
|
Plan sponsor’s
address |
410 EAST LITTLE CANADA ROAD, LITTLE CANADA, MN, 55117
|
Number of participants as of the end of the plan year
Active participants |
116 |
Retired or separated participants receiving
benefits |
4 |
Other
retired or separated participants entitled to future benefits |
0 |
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 |
0 |
Number of participants that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
0 |
Signature of
Role |
Plan administrator |
Date |
2015-12-07 |
Name of individual signing |
NORA COGNETTA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
NORTHEAST RESIDENCE INC HEALTH PLAN
|
2014
|
237309993
|
2015-06-26
|
NORTHEAST RESIDENCE INC
|
57
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
2014-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
6517650217
|
Plan sponsor’s mailing address |
410 E LITTLE CANADA ROAD, LITTLE CANADA, MN, 55117
|
Plan sponsor’s
address |
410 E LITTLE CANADA ROAD, LITTLE CANADA, MN, 55117
|
Number of participants as of the end of the plan year
Active participants |
67 |
Retired or separated participants receiving
benefits |
2 |
Other
retired or separated participants entitled to future benefits |
0 |
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 |
0 |
Number of participants that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
0 |
Signature of
Role |
Plan administrator |
Date |
2015-06-26 |
Name of individual signing |
NORA COGNETTA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
NORTHEAST RESIDENCE INC DENTAL PLAN
|
2013
|
237309993
|
2014-12-11
|
NORTHEAST RESIDENCE INC
|
104
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1999-10-01
|
Business code |
623000
|
Sponsor’s telephone number |
6517650217
|
Plan sponsor’s mailing address |
410 EAST LITTLE CANADA ROAD, LITTLE CANADA, MN, 55117
|
Plan sponsor’s
address |
410 EAST LITTLE CANADA ROAD, LITTLE CANADA, MN, 55117
|
Number of participants as of the end of the plan year
Active participants |
104 |
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 |
Number of
participants
with
account balances as of the end of the plan year |
0 |
Number of participants that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
0 |
Signature of
Role |
Plan administrator |
Date |
2014-12-11 |
Name of individual signing |
NORA COGNETTA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
NORTHEAST RESIDENCE INC LIFE AD&D AND LTD PLAN
|
2013
|
237309993
|
2014-12-29
|
NORTHEAST RESIDENCE INC
|
117
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
1999-10-01
|
Business code |
623000
|
Sponsor’s telephone number |
6517650217
|
Plan sponsor’s mailing address |
410 EAST LITTLE CANADA ROAD, LITTLE CANADA, MN, 55117
|
Plan sponsor’s
address |
410 EAST LITTLE CANADA ROAD, LITTLE CANADA, MN, 55117
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2014-12-29 |
Name of individual signing |
NORA COGNETTA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
NORTHEAST RESIDENCE INC LIFE AD&D AND LTD PLAN
|
2012
|
237309993
|
2014-05-30
|
NORTHEAST RESIDENCE INC
|
102
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
1999-10-01
|
Business code |
623000
|
Sponsor’s telephone number |
6517650217
|
Plan sponsor’s mailing address |
410 EAST LITTLE CANADA ROAD, LITTLE CANADA, MN, 55117
|
Plan sponsor’s
address |
410 EAST LITTLE CANADA ROAD, LITTLE CANADA, MN, 55117
|
Number of participants as of the end of the plan year
Active participants |
116 |
Retired or separated participants receiving
benefits |
1 |
Signature of
Role |
Plan administrator |
Date |
2014-05-30 |
Name of individual signing |
DEBRA LEWANDOWSKI |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2014-05-30 |
Name of individual signing |
DEBRA LEWANDOWSKI |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
NORTHEAST RESIDENCE INC LIFE AD&D AND LTD PLAN
|
2011
|
237309993
|
2013-02-15
|
NORTHEAST RESIDENCE, INC.
|
115
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
1999-10-01
|
Business code |
623000
|
Sponsor’s telephone number |
6517650217
|
Plan sponsor’s mailing address |
410 EAST LITTLE CANADA ROAD, LITTLE CANADA, MN, 55117
|
Plan sponsor’s
address |
410 EAST LITTLE CANADA ROAD, LITTLE CANADA, MN, 55117
|
Plan administrator’s name and address
Administrator’s EIN |
237309993 |
Plan administrator’s name |
NORTHEAST RESIDENCE, INC. |
Plan administrator’s
address |
410 EAST LITTLE CANADA ROAD, LITTLE CANADA, MN, 55117 |
Administrator’s telephone number |
6517650217 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2013-02-15 |
Name of individual signing |
DEBRA LEWANDOWSKI |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-02-15 |
Name of individual signing |
DEBRA LEWANDOWSKI |
Valid signature |
Filed with authorized/valid electronic signature |
|
|