|
CARLEY FOUNDRY, INC. GROUP HEALTH AND WELFARE BENEFIT PLAN
|
2011
|
410914106
|
2013-03-19
|
CARLEY FOUNDRY, INC.
|
239
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2010-04-01
|
| Business code |
331310
|
| Sponsor’s telephone number |
7637805123
|
| Plan sponsor’s mailing address |
8301 CORAL SEA ST NE, BLAINE, MN, 55449
|
| Plan sponsor’s
address |
8301 CORAL SEA ST NE, BLAINE, MN, 55449
|
Plan administrator’s name and address
| Administrator’s EIN |
410914106 |
| Plan administrator’s name |
CARLEY FOUNDRY, INC. |
| Plan administrator’s
address |
8301 CORAL SEA ST NE, BLAINE, MN, 55449 |
| Administrator’s telephone number |
7637805123 |
Number of participants as of the end of the plan year
| Active participants |
201 |
| Retired or separated participants receiving
benefits |
1 |
| Other
retired or separated participants entitled to future benefits |
1 |
Signature of
| Role |
Plan administrator |
| Date |
2013-03-18 |
| Name of individual signing |
CARLY LEPPALA |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2013-03-18 |
| Name of individual signing |
CARLY LEPPALA |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
CARLEY FOUNDRY, INC. 401(K) RETIREMENT PLAN AND TRUST
|
2011
|
410914106
|
2012-07-16
|
CARLEY FOUNDRY, INC.
|
118
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
003
|
| Effective date of plan |
1994-01-01
|
| Business code |
331500
|
| Sponsor’s telephone number |
7637805123
|
| Plan sponsor’s
address |
8301 CORAL SEA STREET NE, MINNEAPOLIS, MN, 55449
|
Plan administrator’s name and address
| Administrator’s EIN |
410914106 |
| Plan administrator’s name |
CARLEY FOUNDRY, INC. |
| Plan administrator’s
address |
8301 CORAL SEA STREET NE, MINNEAPOLIS, MN, 55449 |
| Administrator’s telephone number |
7637805123 |
Signature of
| Role |
Plan administrator |
| Date |
2012-07-16 |
| Name of individual signing |
JORDAN CARLEY |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
CARLEY FOUNDRY INC GROUP HEALTH AND WELFARE BENEFIT PLAN
|
2010
|
410914106
|
2012-05-30
|
CARLEY FOUNDRY INC
|
223
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2010-04-01
|
| Business code |
331310
|
| Sponsor’s telephone number |
7637805123
|
| Plan sponsor’s mailing address |
8301 CORAL SEA ST NE, BLAINE, MN, 55449
|
| Plan sponsor’s
address |
8301 CORAL SEA ST NE, BLAINE, MN, 55449
|
Plan administrator’s name and address
| Administrator’s EIN |
410914106 |
| Plan administrator’s name |
CARLEY FOUNDRY INC |
| Plan administrator’s
address |
8301 CORAL SEA ST NE, BLAINE, MN, 55449 |
| Administrator’s telephone number |
7637805123 |
Number of participants as of the end of the plan year
| Active participants |
223 |
| Retired or separated participants receiving
benefits |
0 |
| Other
retired or separated participants entitled to future benefits |
3 |
| Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
Signature of
| Role |
Plan administrator |
| Date |
2012-05-30 |
| Name of individual signing |
JORDAN CARLEY |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
