CORNELIUS, INC LEGAL, ACCIDENT AND CRITICAL ILLNESS INSURANCE PLANS
|
2018
|
410204600
|
2019-07-26
|
CORNELIUS, INC.
|
57
|
|
File |
View Page
|
Three-digit plan number (PN) |
563
|
Effective date of plan |
2017-01-01
|
Business code |
312110
|
Sponsor’s telephone number |
7634888233
|
Plan sponsor’s mailing address |
101 BROADWAY STREET WEST, SUITE 200, OSSEO, MN, 55369
|
Plan sponsor’s
address |
101 BROADWAY STREET WEST, SUITE 200, OSSEO, MN, 55369
|
Number of participants as of the end of the plan year
Active participants |
35 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2019-07-26 |
Name of individual signing |
THOMAS STANTON |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2019-07-26 |
Name of individual signing |
THOMAS STANTON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CORNELIUS, INC.BUSINESS TRAVEL ACCIDENT INSURANCE PLAN
|
2018
|
410204600
|
2019-07-26
|
CORNELIUS, INC.
|
213
|
|
File |
View Page
|
Three-digit plan number (PN) |
562
|
Effective date of plan |
2015-01-01
|
Business code |
312110
|
Sponsor’s telephone number |
7634888200
|
Plan sponsor’s mailing address |
101 BROADWAY STREET WEST, SUITE 200, OSSEO, MN, 55369
|
Plan sponsor’s
address |
101 BROADWAY STREET WEST, SUITE 200, OSSEO, MN, 55369
|
Number of participants as of the end of the plan year
Active participants |
183 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2019-07-26 |
Name of individual signing |
THOMAS STANTON |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2019-07-26 |
Name of individual signing |
THOMAS STANTON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CORNELIUS, INC. FLEXIBLE SPENDING ACCOUNT PLAN
|
2018
|
410204600
|
2019-07-26
|
CORNELIUS, INC.
|
110
|
|
File |
View Page
|
Three-digit plan number (PN) |
506
|
Effective date of plan |
1990-01-01
|
Business code |
312110
|
Sponsor’s telephone number |
7634888233
|
Plan sponsor’s mailing address |
101 BROADWAY STREET WEST, SUITE 200, OSSEO, MN, 55369
|
Plan sponsor’s
address |
101 BROADWAY STREET WEST, SUITE 200, OSSEO, MN, 55369
|
Number of participants as of the end of the plan year
Active participants |
97 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2019-07-26 |
Name of individual signing |
THOMAS STANTON |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2019-07-26 |
Name of individual signing |
THOMAS STANTON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CORNELIUS, INC. LEGAL, ACCIDENT AND CRITICAL ILLNESS INSURANCE PLANS
|
2017
|
410204600
|
2018-07-16
|
CORNELIUS, INC.
|
60
|
|
File |
View Page
|
Three-digit plan number (PN) |
563
|
Effective date of plan |
2017-01-01
|
Business code |
312110
|
Sponsor’s telephone number |
7634888233
|
Plan sponsor’s mailing address |
101 BROADWAY STREET WEST, SUITE 200, OSSEO, MN, 55369
|
Plan sponsor’s
address |
101 BROADWAY STREET WEST, SUITE 200, OSSEO, MN, 55369
|
Number of participants as of the end of the plan year
Active participants |
57 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2018-07-16 |
Name of individual signing |
THOMAS STANTON |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-07-16 |
Name of individual signing |
THOMAS STANTON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CORNELIUS, INC. BUSINESS TRAVEL ACCIDENT INSURANCE PLAN
|
2017
|
410204600
|
2018-07-16
|
CORNELIUS, INC.
|
233
|
|
File |
View Page
|
Three-digit plan number (PN) |
562
|
Effective date of plan |
2015-01-01
|
Business code |
312110
|
Sponsor’s telephone number |
7634888233
|
Plan sponsor’s mailing address |
101 BROADWAY STREET WEST, SUITE 200, OSSEO, MN, 55369
|
Plan sponsor’s
address |
101 BROADWAY STREET WEST, SUITE 200, OSSEO, MN, 55369
|
Number of participants as of the end of the plan year
Active participants |
214 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2018-07-16 |
Name of individual signing |
THOMAS STANTON |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-07-16 |
Name of individual signing |
THOMAS STANTON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CORNELIUS, INC. FLEXIBLE SPENDING ACCOUNT PLAN
|
2017
|
410204600
|
2018-07-16
|
CORNELIUS, INC.
|
114
|
|
File |
View Page
|
Three-digit plan number (PN) |
506
|
Effective date of plan |
1990-01-01
|
Business code |
312110
|
Sponsor’s telephone number |
7634888233
|
Plan sponsor’s mailing address |
101 BROADWAY STREET WEST, SUITE 200, OSSEO, MN, 55369
|
Plan sponsor’s
address |
101 BROADWAY STREET WEST, SUITE 200, OSSEO, MN, 55369
|
Number of participants as of the end of the plan year
Active participants |
101 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2018-07-16 |
Name of individual signing |
THOMAS STANTON |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-07-16 |
Name of individual signing |
THOMAS STANTON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CORNELIUS, INC. BUSINESS TRAVEL ACCIDENT INSURANCE PLAN
|
2016
|
410204600
|
2017-07-24
|
CORNELIUS, INC.
|
271
|
|
File |
View Page
|
Three-digit plan number (PN) |
562
|
Effective date of plan |
2015-01-01
|
Business code |
312110
|
Sponsor’s telephone number |
7634888200
|
Plan sponsor’s mailing address |
101 BROADWAY STREET WEST, SUITE 200, OSSEO, MN, 55369
|
Plan sponsor’s
address |
101 BROADWAY STREET WEST, SUITE 200, OSSEO, MN, 55369
|
Number of participants as of the end of the plan year
Active participants |
283 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2017-07-24 |
Name of individual signing |
THOMAS STANTON |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2017-07-24 |
Name of individual signing |
THOMAS STANTON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CORNELIUS, INC. FLEXIBLE SPENDING ACCOUNT PLAN
|
2016
|
410204600
|
2017-07-24
|
CORNELIUS, INC.
|
121
|
|
File |
View Page
|
Three-digit plan number (PN) |
506
|
Effective date of plan |
1990-01-01
|
Business code |
312110
|
Sponsor’s telephone number |
7634888233
|
Plan sponsor’s mailing address |
101 BROADWAY STREET WEST, SUITE 200, OSSEO, MN, 55369
|
Plan sponsor’s
address |
101 BROADWAY STREET WEST, SUITE 200, OSSEO, MN, 55369
|
Number of participants as of the end of the plan year
Active participants |
115 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2017-07-24 |
Name of individual signing |
THOMAS STANTON |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2017-07-24 |
Name of individual signing |
THOMAS STANTON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CORNELIUS, INC. FLEXIBLE SPENDING ACCOUNT PLAN
|
2015
|
410204600
|
2016-07-01
|
CORNELIUS, INC.
|
105
|
|
File |
View Page
|
Three-digit plan number (PN) |
506
|
Effective date of plan |
1990-01-01
|
Business code |
312110
|
Sponsor’s telephone number |
7634888233
|
Plan sponsor’s mailing address |
101 BROADWAY STREET WEST, SUITE 200, OSSEO, MN, 55369
|
Plan sponsor’s
address |
101 BROADWAY STREET WEST, SUITE 200, OSSEO, MN, 55369
|
Number of participants as of the end of the plan year
Active participants |
97 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2016-07-01 |
Name of individual signing |
THOMAS STANTON |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2016-07-01 |
Name of individual signing |
THOMAS STANTON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CORNELIUS, INC. BUSINESS TRAVEL ACCIDENT INSURANCE PLAN
|
2015
|
410204600
|
2016-07-01
|
CORNELIUS, INC.
|
251
|
|
File |
View Page
|
Three-digit plan number (PN) |
562
|
Effective date of plan |
2015-01-01
|
Business code |
312110
|
Sponsor’s telephone number |
7634888200
|
Plan sponsor’s mailing address |
101 BROADWAY STREET WEST, SUITE 200, OSSEO, MN, 55369
|
Plan sponsor’s
address |
101 BROADWAY STREET WEST, SUITE 200, OSSEO, MN, 55369
|
Number of participants as of the end of the plan year
Active participants |
273 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2016-07-01 |
Name of individual signing |
THOMAS STANTON |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2016-07-01 |
Name of individual signing |
THOMAS STANTON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|