|
HAZELDEN BETTY FORD FOUNDATION WELFARE PLAN
|
2018
|
410682405
|
2019-10-10
|
HAZELDEN BETTY FORD FOUNDATION
|
1518
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2007-01-01
|
| Business code |
621420
|
| Sponsor’s telephone number |
6512134900
|
| Plan sponsor’s mailing address |
PO BOX 11, CENTER CITY, MN, 550120011
|
| Plan sponsor’s
address |
15251 PLEASANT VALLEY RD, CENTER CITY, MN, 55012
|
Number of participants as of the end of the plan year
Signature of
| Role |
Plan administrator |
| Date |
2019-10-10 |
| Name of individual signing |
JAMES BLAHA |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2019-10-10 |
| Name of individual signing |
JAMES BLAHA |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
HAZELDEN BETTY FORD FOUNDATION WELFARE PLAN
|
2017
|
410682405
|
2018-08-22
|
HAZELDEN BETTY FORD FOUNDATION
|
1657
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2007-01-01
|
| Business code |
621420
|
| Sponsor’s telephone number |
6512134900
|
| Plan sponsor’s mailing address |
PO BOX 11, CENTER CITY, MN, 550120011
|
| Plan sponsor’s
address |
15251 PLEASANT VALLEY RD, CENTER CITY, MN, 55012
|
Number of participants as of the end of the plan year
Signature of
| Role |
Plan administrator |
| Date |
2018-08-22 |
| Name of individual signing |
JAMES BLAHA |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2018-08-22 |
| Name of individual signing |
JAMES BLAHA |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
HAZELDEN BETTY FORD FOUNDATION WELFARE PLAN
|
2016
|
410682405
|
2017-07-27
|
HAZELDEN BETTY FORD FOUNDATION
|
1575
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2007-01-01
|
| Business code |
621420
|
| Sponsor’s telephone number |
6512134900
|
| Plan sponsor’s mailing address |
PO BOX 11, CENTER CITY, MN, 550120011
|
| Plan sponsor’s
address |
15251 PLEASANT VALLEY ROAD, CENTER CITY, MN, 550120011
|
Number of participants as of the end of the plan year
Signature of
| Role |
Plan administrator |
| Date |
2017-07-25 |
| Name of individual signing |
JAMES BLAHA |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2017-07-25 |
| Name of individual signing |
JAMES BLAHA |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
HAZELDEN BETTY FORD FOUNDATION WELFARE PLAN
|
2015
|
410682405
|
2016-07-26
|
HAZELDEN BETTY FORD FOUNDATION
|
1337
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2007-01-01
|
| Business code |
621420
|
| Sponsor’s telephone number |
6512134900
|
| Plan sponsor’s mailing address |
PO BOX 11, CENTER CITY, MN, 550120011
|
| Plan sponsor’s
address |
15251 PLEASANT VALLEY ROAD, CENTER CITY, MN, 55012
|
Number of participants as of the end of the plan year
Signature of
| Role |
Plan administrator |
| Date |
2016-07-26 |
| Name of individual signing |
JAMES BLAHA |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2016-07-26 |
| Name of individual signing |
JAMES BLAHA |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
THE HAZELDEN BETTY FORD FOUNDATION WELFARE PLAN
|
2014
|
410682405
|
2015-07-30
|
HAZELDEN BETTY FORD FOUNDATION
|
1278
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2007-01-01
|
| Business code |
621420
|
| Sponsor’s telephone number |
6512134900
|
| Plan sponsor’s mailing address |
PO BOX 11, CENTER CITY, MN, 55012
|
| Plan sponsor’s
address |
15251 PLEASANT VALLEY ROAD, CENTER CITY, MN, 55012
|
Number of participants as of the end of the plan year
| Active participants |
1337 |
| 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 |
Signature of
| Role |
Plan administrator |
| Date |
2015-07-30 |
| Name of individual signing |
JAMES BLAHA |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2015-07-30 |
| Name of individual signing |
JAMES BLAHA |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
