HVH AUTO PARTS EMPLOYEE MEDICAL BENEFIT PLAN
|
2012
|
411300320
|
2013-07-10
|
HVH AUTO PARTS, INC
|
81
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1992-02-01
|
Business code |
441300
|
Sponsor’s telephone number |
6127162561
|
Plan
sponsor’s DBA name |
JOHNS AUTO PARTS
|
Plan sponsor’s mailing address |
16971 WARD LAKE DRIVE NW, ANDOVER, MN, 55304
|
Plan sponsor’s
address |
10506 CENTRAL AVENUE NE, BLAINE, MN, 55434
|
Number of participants as of the end of the plan year
Active participants |
0 |
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 |
2013-07-10 |
Name of individual signing |
LINDA HALUPTZOK |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-07-10 |
Name of individual signing |
LINDA HALUPTZOK |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
HVH AUTO PARTS EMPLOYEE MEDICAL BENEFIT PLAN
|
2011
|
411300320
|
2012-12-21
|
HVH AUTO PARTS INC
|
82
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1992-02-01
|
Business code |
441300
|
Sponsor’s telephone number |
7637832231
|
Plan
sponsor’s DBA name |
JOHNS AUTO PARTS
|
Plan sponsor’s mailing address |
10506 CENTRAL AVENUE NE, BLAINE, MN, 55434
|
Plan sponsor’s
address |
10506 CENTRAL AVENUE NE, BLAINE, MN, 55434
|
Plan administrator’s name and address
Administrator’s EIN |
411300320 |
Plan administrator’s name |
HVH AUTO PARTS INC |
Plan administrator’s
address |
10506 CENTRAL AVENUE NE, BLAINE, MN, 55434 |
Administrator’s telephone number |
7637832231 |
Number of participants as of the end of the plan year
Active participants |
80 |
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 |
1 |
Signature of
Role |
Plan administrator |
Date |
2012-12-21 |
Name of individual signing |
LINDA HALUPTZOK |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
HVH AUTO PARTS EMPLOYEE MEDICAL BENEFIT PLAN
|
2010
|
411300320
|
2012-04-13
|
HVH AUTO PARTS INC
|
81
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1992-02-01
|
Business code |
441300
|
Sponsor’s telephone number |
7637832231
|
Plan
sponsor’s DBA name |
JOHNS AUTO PARTS
|
Plan sponsor’s mailing address |
10506 CENTRAL AVENUE NE, BLAINE, MN, 55434
|
Plan sponsor’s
address |
10506 CENTRAL AVENUE NE, BLAINE, MN, 55434
|
Plan administrator’s name and address
Administrator’s EIN |
411300320 |
Plan administrator’s name |
HVH AUTO PARTS INC |
Plan administrator’s
address |
10506 CENTRAL AVENUE NE, BLAINE, MN, 55434 |
Administrator’s telephone number |
7637832231 |
Number of participants as of the end of the plan year
Active participants |
82 |
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 that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
0 |
Signature of
Role |
Plan administrator |
Date |
2012-04-13 |
Name of individual signing |
LINDA HALUPTZOK |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
HVH AUTO PARTS EMPLOYEE MEDICAL BENEFIT PLAN
|
2009
|
411300320
|
2012-04-13
|
HVH AUTO PARTS INC
|
69
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1992-02-01
|
Business code |
441300
|
Sponsor’s telephone number |
7637832231
|
Plan
sponsor’s DBA name |
JOHNS AUTO PARTS
|
Plan sponsor’s mailing address |
10506 CENTRAL AVENUE NE, BLAINE, MN, 55434
|
Plan sponsor’s
address |
10506 CENTRAL AVENUE NE, BLAINE, MN, 55434
|
Plan administrator’s name and address
Administrator’s EIN |
411300320 |
Plan administrator’s name |
HVH AUTO PARTS INC |
Plan administrator’s
address |
10506 CENTRAL AVENUE NE, BLAINE, MN, 55434 |
Administrator’s telephone number |
7637832231 |
Number of participants as of the end of the plan year
Active participants |
75 |
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 that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
0 |
Signature of
Role |
Plan administrator |
Date |
2012-04-13 |
Name of individual signing |
LINDA HALUPTZOK |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
HVH AUTO PARTS EMPLOYEE MEDICAL BENEFIT PLAN
|
2009
|
410300320
|
2011-03-17
|
HVH AUTO PARTS INC
|
69
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1992-02-01
|
Business code |
441300
|
Sponsor’s telephone number |
7637841711
|
Plan
sponsor’s DBA name |
JOHNS AUTO PARTS
|
Plan sponsor’s mailing address |
10506 CENTRAL AVENUE NE, BLAINE, MN, 55434
|
Plan sponsor’s
address |
10506 CENTRAL AVENUE NE, BLAINE, MN, 55434
|
Plan administrator’s name and address
Administrator’s EIN |
410300320 |
Plan administrator’s name |
HVH AUTO PARTS INC |
Plan administrator’s
address |
10506 CENTRAL AVENUE NE, BLAINE, MN, 55434 |
Administrator’s telephone number |
7637841711 |
Number of participants as of the end of the plan year
Active participants |
75 |
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 that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
0 |
Signature of
Role |
Plan administrator |
Date |
2011-03-17 |
Name of individual signing |
LINDA HALUPTZOK |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
HVH AUTO PARTS EMPLOYEE MEDICAL BENEFIT PLAN
|
2009
|
411300320
|
2010-05-28
|
HVH AUTO PARTS, INC
|
67
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1992-02-01
|
Business code |
441300
|
Sponsor’s telephone number |
7637841711
|
Plan
sponsor’s DBA name |
JOHNS AUTO PARTS
|
Plan sponsor’s mailing address |
10506 CENTRAL AVENUE NE, BLAINE, MN, 55434
|
Plan sponsor’s
address |
10506 CENTRAL AVENUE NE, BLAINE, MN, 55434
|
Plan administrator’s name and address
Administrator’s EIN |
411300320 |
Plan administrator’s name |
HVH AUTO PARTS, INC |
Plan administrator’s
address |
10506 CENTRAL AVENUE NE, BLAINE, MN, 55434 |
Administrator’s telephone number |
7637841711 |
Number of participants as of the end of the plan year
Active participants |
69 |
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 |
2010-05-28 |
Name of individual signing |
LINDA HALUPTZOK |
Valid signature |
Filed with authorized/valid electronic signature |
|
|