LE SUEUR INCORPORATED EMPLOYEE BENEFIT PROGRAM
|
2021
|
410643307
|
2023-03-31
|
LE SUEUR INCORPORATED
|
318
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1987-09-01
|
Business code |
331310
|
Sponsor’s telephone number |
5076656204
|
Plan sponsor’s mailing address |
PO BOX 149, LE SUEUR, MN, 560580149
|
Plan sponsor’s
address |
1409 VINE STREET, LE SUEUR, MN, 56058
|
Number of participants as of the end of the plan year
Active participants |
308 |
Retired or separated participants receiving
benefits |
1 |
Signature of
Role |
Plan administrator |
Date |
2023-03-31 |
Name of individual signing |
MICHAEL JINDRA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2023-03-31 |
Name of individual signing |
MICHAEL JINDRA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LE SUEUR INCORPORATED SHORT TERM DISABILITY PLAN
|
2021
|
410643307
|
2023-03-31
|
LE SUEUR INCORPORATED
|
314
|
|
File |
View Page
|
Three-digit plan number (PN) |
507
|
Effective date of plan |
2011-09-03
|
Business code |
331310
|
Sponsor’s telephone number |
5076656204
|
Plan sponsor’s mailing address |
PO BOX 149, LE SUEUR, MN, 560580149
|
Plan sponsor’s
address |
1409 VINE STREET, LE SUEUR, MN, 56058
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2023-03-31 |
Name of individual signing |
MICHAEL JINDRA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2023-03-31 |
Name of individual signing |
MICHAEL JINDRA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LE SUEUR INCORPORATED HEALTH CARE PLAN
|
2021
|
410643307
|
2023-03-31
|
LE SUEUR INCORPORATED
|
268
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
1987-09-01
|
Business code |
331310
|
Sponsor’s telephone number |
5076656204
|
Plan sponsor’s mailing address |
PO BOX 149, LE SUEUR, MN, 560580149
|
Plan sponsor’s
address |
1409 VINE STREET, LE SUEUR, MN, 56058
|
Number of participants as of the end of the plan year
Active participants |
252 |
Retired or separated participants receiving
benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2023-03-31 |
Name of individual signing |
MICHAEL JINDRA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2023-03-31 |
Name of individual signing |
MICHAEL JINDRA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LE SUEUR INCORPORATED VOLUNTARY LONG TERM
|
2021
|
410643307
|
2023-03-31
|
LE SUEUR INCORPORATED
|
157
|
|
File |
View Page
|
Three-digit plan number (PN) |
509
|
Effective date of plan |
2016-07-01
|
Business code |
331310
|
Sponsor’s telephone number |
5076656204
|
Plan sponsor’s mailing address |
PO BOX 149, LE SUEUR, MN, 560580149
|
Plan sponsor’s
address |
1409 VINE STREET, LE SUEUR, MN, 56058
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2023-03-31 |
Name of individual signing |
MICHAEL JINDRA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2023-03-31 |
Name of individual signing |
MICHAEL JINDRA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LE SUEUR INCORPORATED DENTAL PLAN
|
2021
|
410643307
|
2023-03-31
|
LE SUEUR INCORPORATED
|
277
|
|
File |
View Page
|
Three-digit plan number (PN) |
508
|
Effective date of plan |
2011-09-03
|
Business code |
331310
|
Sponsor’s telephone number |
5076656204
|
Plan sponsor’s mailing address |
PO BOX 149, LE SUEUR, MN, 560580149
|
Plan sponsor’s
address |
1409 VINE STREET, LE SUEUR, MN, 56058
|
Number of participants as of the end of the plan year
Active participants |
260 |
Retired or separated participants receiving
benefits |
4 |
Signature of
Role |
Plan administrator |
Date |
2023-03-31 |
Name of individual signing |
MICHAEL JINDRA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2023-03-31 |
Name of individual signing |
MICHAEL JINDRA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LE SUEUR INCORPORATED HEALTH CARE PLAN
|
2020
|
410643307
|
2022-03-31
|
LE SUEUR INCORPORATED
|
294
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
1987-09-01
|
Business code |
331310
|
Sponsor’s telephone number |
5076656204
|
Plan sponsor’s mailing address |
PO BOX 149, LE SUEUR, MN, 560580149
|
Plan sponsor’s
address |
1409 VINE STREET, LE SUEUR, MN, 56058
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2022-03-31 |
Name of individual signing |
MICHAEL JINDRA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LE SUEUR INCORPORATED EMPLOYEE BENEFIT PROGRAM
|
2020
|
410643307
|
2022-03-31
|
LE SUEUR INCORPORATED
|
334
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1987-09-01
|
Business code |
331310
|
Sponsor’s telephone number |
5076656204
|
Plan sponsor’s mailing address |
PO BOX 149, LE SUEUR, MN, 560580149
|
Plan sponsor’s
address |
1409 VINE STREET, LE SUEUR, MN, 56058
|
Number of participants as of the end of the plan year
Active participants |
317 |
Other
retired or separated participants entitled to future benefits |
1 |
Signature of
Role |
Plan administrator |
Date |
2022-03-31 |
Name of individual signing |
MICHAEL JINDRA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LE SUEUR INCORPORATED SHORT TERM DISABILITY PLAN
|
2020
|
410643307
|
2022-03-31
|
LE SUEUR INCORPORATED
|
330
|
|
File |
View Page
|
Three-digit plan number (PN) |
507
|
Effective date of plan |
2011-09-03
|
Business code |
331310
|
Sponsor’s telephone number |
5076656204
|
Plan sponsor’s mailing address |
PO BOX 149, LE SUEUR, MN, 560580149
|
Plan sponsor’s
address |
1490 VINE STREET, LE SUEUR, MN, 56058
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2022-03-31 |
Name of individual signing |
MICHAEL JINDRA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LE SUEUR INCORPORATED VOLUNTARY LONG TERM
|
2020
|
410643307
|
2022-03-31
|
LE SUEUR INCORPORATED
|
128
|
|
File |
View Page
|
Three-digit plan number (PN) |
509
|
Effective date of plan |
2016-07-01
|
Business code |
331310
|
Sponsor’s telephone number |
5076656204
|
Plan sponsor’s mailing address |
PO BOX 149, LE SUEUR, MN, 560580149
|
Plan sponsor’s
address |
1409 VINE STREET, LE SUEUR, MN, 56058
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2022-03-31 |
Name of individual signing |
MICHAEL JINDRA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LE SUEUR INCORPORATED DENTAL PLAN
|
2020
|
410643307
|
2022-03-31
|
LE SUEUR INCORPORATED
|
296
|
|
File |
View Page
|
Three-digit plan number (PN) |
508
|
Effective date of plan |
2011-09-03
|
Business code |
331310
|
Sponsor’s telephone number |
5076656204
|
Plan sponsor’s mailing address |
PO BOX 149, LE SUEUR, MN, 560580149
|
Plan sponsor’s
address |
1409 VINE STREET, LE SUEUR, MN, 56058
|
Number of participants as of the end of the plan year
Active participants |
276 |
Retired or separated participants receiving
benefits |
1 |
Signature of
Role |
Plan administrator |
Date |
2022-03-31 |
Name of individual signing |
MICHAEL JINDRA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|