API LIFE INSURANCE PLAN
|
2015
|
263319840
|
2016-08-01
|
AMUNDSON PETERSON INC
|
118
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2012-01-01
|
Business code |
441228
|
Sponsor’s telephone number |
2186854438
|
Plan sponsor’s mailing address |
PO BOX 973, ELBOW LAKE, MN, 565310973
|
Plan sponsor’s
address |
110 2ND STREET, ELBOW LAKE, MN, 56531
|
Number of participants as of the end of the plan year
Active participants |
111 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2016-08-01 |
Name of individual signing |
TERRY AMUNDSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2016-08-01 |
Name of individual signing |
TERRY AMUNDSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
API SHORT TERM DISABILITY PLAN
|
2015
|
263319840
|
2016-09-12
|
AMUNDSON PETERSON INC
|
113
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
2014-01-01
|
Business code |
441228
|
Sponsor’s telephone number |
2186854438
|
Plan sponsor’s mailing address |
PO BOX 973, ELBOW LAKE, MN, 565310973
|
Plan sponsor’s
address |
110 2ND STREET, ELBOW LAKE, MN, 56531
|
Number of participants as of the end of the plan year
Active participants |
106 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2016-09-12 |
Name of individual signing |
TERRY AMUNDSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
API MEDICAL PLAN
|
2014
|
263319840
|
2015-07-31
|
AMUNDSON PETERSON INC
|
101
|
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2012-01-01
|
Business code |
441228
|
Sponsor’s telephone number |
2186854438
|
Plan sponsor’s mailing address |
PO BOX 973, ELBOW LAKE, MN, 565310973
|
Plan sponsor’s
address |
110 2ND STREET NE, ELBOW LAKE, MN, 56531
|
Number of participants as of the end of the plan year
Active participants |
98 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2015-07-31 |
Name of individual signing |
TERRY AMUNDSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
API LIFE INSURANCE PLAN
|
2014
|
263319840
|
2015-07-31
|
AMUNDSON PETERSON INC
|
120
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2012-01-01
|
Business code |
441228
|
Sponsor’s telephone number |
2186854438
|
Plan sponsor’s mailing address |
PO BOX 973, ELBOW LAKE, MN, 565310973
|
Plan sponsor’s
address |
110 2ND STREET NE, ELBOW LAKE, MN, 56531
|
Number of participants as of the end of the plan year
Active participants |
120 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2015-07-31 |
Name of individual signing |
TERRY AMUNDSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
API SHORT TERM DISABILITY PLAN
|
2014
|
263319840
|
2015-07-31
|
AMUNDSON PETERSON INC
|
115
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
2014-01-01
|
Business code |
441228
|
Sponsor’s telephone number |
2186854438
|
Plan sponsor’s mailing address |
PO BOX 973, ELBOW LAKE, MN, 565310973
|
Plan sponsor’s
address |
110 2ND STREET NE, ELBOW LAKE, MN, 56531
|
Number of participants as of the end of the plan year
Active participants |
114 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2015-07-31 |
Name of individual signing |
TERRY AMUNDSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
AMUNDSON-PETERSON INC. 401(K) PROFIT SHARING PLAN
|
2014
|
263319840
|
2015-03-20
|
AMUNDSON-PETERSON INC.
|
107
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1975-01-31
|
Business code |
423800
|
Sponsor’s telephone number |
2186854438
|
Plan sponsor’s
address |
110 2ND STREET, PO BOX 973, ELBOW LAKE, MN, 565310973
|
Plan administrator’s name and address
Administrator’s EIN |
263319840 |
Plan administrator’s name |
AMUNDSON-PETERSON INC. |
Plan administrator’s
address |
110 2ND STREET, PO BOX 973, ELBOW LAKE, MN, 565310973 |
Administrator’s telephone number |
2186854438 |
Signature of
Role |
Plan administrator |
Date |
2015-03-20 |
Name of individual signing |
RYAN AMUNDSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
AMUNDSON-PETERSON INC. 401(K) PROFIT SHARING PLAN
|
2013
|
263319840
|
2014-04-16
|
AMUNDSON-PETERSON INC.
|
93
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1975-01-31
|
Business code |
423800
|
Sponsor’s telephone number |
2186854438
|
Plan sponsor’s
address |
110 2ND STREET, PO BOX 973, ELBOW LAKE, MN, 565310973
|
Plan administrator’s name and address
Administrator’s EIN |
263319840 |
Plan administrator’s name |
AMUNDSON-PETERSON INC. |
Plan administrator’s
address |
110 2ND STREET, PO BOX 973, ELBOW LAKE, MN, 565310973 |
Administrator’s telephone number |
2186854438 |
Signature of
Role |
Plan administrator |
Date |
2014-04-16 |
Name of individual signing |
RYAN AMUNDSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
AMUNDSON-PETERSON INC. 401(K) PROFIT SHARING PLAN
|
2012
|
263319840
|
2013-05-28
|
AMUNDSON-PETERSON INC.
|
93
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1975-01-31
|
Business code |
423800
|
Sponsor’s telephone number |
2186854438
|
Plan sponsor’s
address |
110 2ND STREET, PO BOX 973, ELBOW LAKE, MN, 565310973
|
Plan administrator’s name and address
Administrator’s EIN |
263319840 |
Plan administrator’s name |
AMUNDSON-PETERSON INC. |
Plan administrator’s
address |
110 2ND STREET, PO BOX 973, ELBOW LAKE, MN, 565310973 |
Administrator’s telephone number |
2186854438 |
Signature of
Role |
Plan administrator |
Date |
2013-05-28 |
Name of individual signing |
RYAN AMUNDSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|