X-CEL GROUP LIFE AND HOSPITALIZATION
|
2016
|
411457250
|
2017-06-15
|
X-CEL OPTICAL COMPANY
|
80
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1984-03-01
|
Business code |
339110
|
Sponsor’s telephone number |
3202518404
|
Plan sponsor’s mailing address |
806 S BENTON DR, SAUK RAPIDS, MN, 563791206
|
Plan sponsor’s
address |
806 S BENTON DR, SAUK RAPIDS, MN, 563791206
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2017-06-15 |
Name of individual signing |
WAYNE GOTTWALT |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2017-06-15 |
Name of individual signing |
WAYNE GOTTWALT |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
X-CEL GROUP LIFE AND HOSPITALIZATION
|
2014
|
411457250
|
2015-05-11
|
X-CEL OPTICAL COMPANY
|
130
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1984-03-01
|
Business code |
339110
|
Sponsor’s telephone number |
3202518404
|
Plan sponsor’s mailing address |
PO BOX 420, 806 S BENTON DRIVE, SAUK RAPIDS, MN, 56379
|
Plan sponsor’s
address |
PO BOX 420, 806 S BENTON DRIVE, SAUK RAPIDS, MN, 56379
|
Number of participants as of the end of the plan year
Active participants |
113 |
Retired or separated participants receiving
benefits |
6 |
Signature of
Role |
Plan administrator |
Date |
2015-05-11 |
Name of individual signing |
WAYNE GOTTWALT |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2015-05-11 |
Name of individual signing |
WAYNE GOTTWALT |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
X-CEL OPTICAL GROUP LIFE AND HOSPITALIZATION
|
2013
|
411457250
|
2014-05-13
|
X-CEL OPTICAL COMPANY
|
142
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1984-03-01
|
Business code |
339110
|
Sponsor’s telephone number |
3202518404
|
Plan sponsor’s mailing address |
PO BOX 420, 806 S BENTON DRIVE, SAUK RAPIDS, MN, 56379
|
Plan sponsor’s
address |
PO BOX 420, 806 S BENTON DRIVE, SAUK RAPIDS, MN, 56379
|
Number of participants as of the end of the plan year
Active participants |
117 |
Retired or separated participants receiving
benefits |
13 |
Signature of
Role |
Plan administrator |
Date |
2014-05-13 |
Name of individual signing |
WAYNE GOTTWALT |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2014-05-13 |
Name of individual signing |
WAYNE GOTTWALT |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
X-CEL OPTICAL GROUP LIFE AND HOSPITALIZATION
|
2012
|
411457250
|
2013-05-14
|
X-CEL OPTICAL COMPANY
|
153
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1984-03-01
|
Business code |
339110
|
Sponsor’s telephone number |
3202518404
|
Plan sponsor’s mailing address |
PO BOX 420, 806 S BENTON DRIVE, SAUK RAPIDS, MN, 563790420
|
Plan sponsor’s
address |
PO BOX 420, 806 S BENTON DRIVE, SAUK RAPIDS, MN, 563790420
|
Number of participants as of the end of the plan year
Active participants |
140 |
Retired or separated participants receiving
benefits |
6 |
Signature of
Role |
Plan administrator |
Date |
2013-05-14 |
Name of individual signing |
WAYNE GOTTWALT |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-05-14 |
Name of individual signing |
WAYNE GOTTWALT |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
X-CEL OPTICAL GROUP LIFE AND HOSPITALIZATION
|
2011
|
411457250
|
2012-05-08
|
X-CEL OPTICAL COMPANY
|
160
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1984-03-01
|
Business code |
339110
|
Sponsor’s telephone number |
3202518404
|
Plan sponsor’s mailing address |
PO BOX 420, 806 S BENTON DRIVE, SAUK RAPIDS, MN, 563790420
|
Plan sponsor’s
address |
PO BOX 420, 806 S BENTON DRIVE, SAUK RAPIDS, MN, 563790420
|
Plan administrator’s name and address
Administrator’s EIN |
411457250 |
Plan administrator’s name |
X-CEL OPTICAL COMPANY |
Plan administrator’s
address |
PO BOX 420, 806 S BENTON DRIVE, SAUK RAPIDS, MN, 563790420 |
Administrator’s telephone number |
3202518404 |
Number of participants as of the end of the plan year
Active participants |
149 |
Retired or separated participants receiving
benefits |
6 |
Signature of
Role |
Plan administrator |
Date |
2012-05-08 |
Name of individual signing |
WAYNE GOTTWALT |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
X-CEL OPTICAL GROUP LIFE AND HOSPITALIZATION
|
2010
|
411457250
|
2011-05-13
|
X-CEL OPTICAL COMPANY
|
157
|
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1984-03-01
|
Business code |
339110
|
Sponsor’s telephone number |
3202518404
|
Plan sponsor’s mailing address |
PO BOX 420, 806 S BENTON DRIVE, SAUK RAPIDS, MN, 563790420
|
Plan sponsor’s
address |
PO BOX 420, 806 S BENTON DRIVE, SAUK RAPIDS, MN, 563790420
|
Plan administrator’s name and address
Administrator’s EIN |
411457250 |
Plan administrator’s name |
X-CEL OPTICAL COMPANY |
Plan administrator’s
address |
PO BOX 420, 806 S BENTON DRIVE, SAUK RAPIDS, MN, 563790420 |
Administrator’s telephone number |
3202518404 |
Number of participants as of the end of the plan year
Active participants |
156 |
Retired or separated participants receiving
benefits |
2 |
Signature of
Role |
Employer/plan sponsor |
Date |
2011-05-13 |
Name of individual signing |
WAYNE GOTTWALT |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
X-CEL OPTICAL GROUP LIFE AND HOSPITALIZATION
|
2010
|
411457250
|
2011-05-17
|
X-CEL OPTICAL COMPANY
|
157
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1984-03-01
|
Business code |
339110
|
Sponsor’s telephone number |
3202518404
|
Plan sponsor’s mailing address |
PO BOX 420, 806 S BENTON DRIVE, SAUK RAPIDS, MN, 563790420
|
Plan sponsor’s
address |
PO BOX 420, 806 S BENTON DRIVE, SAUK RAPIDS, MN, 563790420
|
Plan administrator’s name and address
Administrator’s EIN |
411457250 |
Plan administrator’s name |
X-CEL OPTICAL COMPANY |
Plan administrator’s
address |
PO BOX 420, 806 S BENTON DRIVE, SAUK RAPIDS, MN, 563790420 |
Administrator’s telephone number |
3202518404 |
Number of participants as of the end of the plan year
Active participants |
156 |
Retired or separated participants receiving
benefits |
2 |
Signature of
Role |
Plan administrator |
Date |
2011-05-17 |
Name of individual signing |
WAYNE GOTTWALT |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
X-CEL OPTICAL GROUP LIFE AND HOSPITALIZATION
|
2009
|
411457250
|
2010-05-14
|
X-CEL OPTICAL COMPANY
|
160
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1984-03-01
|
Business code |
339110
|
Sponsor’s telephone number |
3202518404
|
Plan sponsor’s mailing address |
PO BOX 420, 806 S BENTON DRIVE, SAUK RAPIDS, MN, 563790420
|
Plan sponsor’s
address |
PO BOX 420, 806 S BENTON DRIVE, SAUK RAPIDS, MN, 563790420
|
Plan administrator’s name and address
Administrator’s EIN |
411457250 |
Plan administrator’s name |
X-CEL OPTICAL COMPANY |
Plan administrator’s
address |
PO BOX 420, 806 S BENTON DRIVE, SAUK RAPIDS, MN, 563790420 |
Administrator’s telephone number |
3202518404 |
Number of participants as of the end of the plan year
Active participants |
150 |
Retired or separated participants receiving
benefits |
4 |
Signature of
Role |
Employer/plan sponsor |
Date |
2010-05-14 |
Name of individual signing |
WAYNE GOTTWALT |
Valid signature |
Filed with authorized/valid electronic signature |
|
|