|
LONG TERM DISABILITY
|
2018
|
411400806
|
2019-07-08
|
MAYFLOWER DISTRIBUTING
|
142
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
502
|
| Effective date of plan |
2018-01-01
|
| Business code |
424990
|
| Sponsor’s telephone number |
6514682081
|
| Plan
sponsor’s DBA name |
MAYFLOWER DISTRIBUTING
|
| Plan sponsor’s mailing address |
1155 MEDALLION DR, MENDOTA HEIGHTS, MN, 551201220
|
| Plan sponsor’s
address |
1155 MEDALLION DR, MENDOTA HEIGHTS, MN, 551201220
|
Plan administrator’s name and address
| Administrator’s EIN |
231503749 |
| Plan administrator’s name |
CIGNA GROUP INSURANCE |
| Plan administrator’s
address |
PO BOX 20643, LEHIGH VALLEY, PA, 180020643 |
| Administrator’s telephone number |
6107587798 |
Number of participants as of the end of the plan year
| Active participants |
139 |
| 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 |
2019-07-08 |
| Name of individual signing |
KIM WAGNER |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
LONG TERM DISABILITY
|
2018
|
411400806
|
2019-07-08
|
MAYFLOWER DISTRIBUTING
|
142
|
|
| Three-digit plan number (PN) |
502
|
| Effective date of plan |
2018-01-01
|
| Business code |
424990
|
| Sponsor’s telephone number |
6514682081
|
| Plan
sponsor’s DBA name |
MAYFLOWER DISTRIBUTING
|
| Plan sponsor’s mailing address |
1155 MEDALLION DR, MENDOTA HEIGHTS, MN, 551201220
|
| Plan sponsor’s
address |
1155 MEDALLION DR, MENDOTA HEIGHTS, MN, 551201220
|
Plan administrator’s name and address
| Administrator’s EIN |
231503749 |
| Plan administrator’s name |
CIGNA GROUP INSURANCE |
| Plan administrator’s
address |
PO BOX 20643, LEHIGH VALLEY, PA, 180020643 |
| Administrator’s telephone number |
6107587798 |
Number of participants as of the end of the plan year
| Active participants |
139 |
| 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 |
2019-07-08 |
| Name of individual signing |
KIM WAGNER |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
LONG TERM DISABILITY
|
2017
|
411400806
|
2018-06-11
|
MAYFLOWER DISTRIBUTING COMPANY, INC
|
122
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
502
|
| Effective date of plan |
2017-01-01
|
| Business code |
424990
|
| Sponsor’s telephone number |
6514682081
|
| Plan
sponsor’s DBA name |
DISTRIBUTION CENTER
|
| Plan sponsor’s mailing address |
1155 MEDALLION DR, MENDOTA HEIGHTS, MN, 551201220
|
| Plan sponsor’s
address |
1155 MEDALLION DR, MENDOTA HEIGHTS, MN, 551201220
|
Plan administrator’s name and address
| Administrator’s EIN |
231503749 |
| Plan administrator’s name |
CIGNA GROUP INSURANCE |
| Plan administrator’s
address |
PO BOX 20643, LEHIGH VALLEY, PA, 180020643 |
| Administrator’s telephone number |
6107587798 |
Number of participants as of the end of the plan year
| Active participants |
134 |
| 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 |
2018-06-11 |
| Name of individual signing |
KIM WAGNER |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
MAYFLOWER DISTRIBUTING COMPANY, INC.
|
2016
|
411400806
|
2017-07-12
|
MAYFLOWER DISTRIBUTING COMPANY, INC.
|
122
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2016-01-01
|
| Business code |
424990
|
| Sponsor’s telephone number |
6514682081
|
| Plan
sponsor’s DBA name |
DISTRIBUTION COMPANY
|
| Plan sponsor’s mailing address |
1155 MEDALLION DR, MENDOTA HEIGHTS, MN, 551201220
|
| Plan sponsor’s
address |
1155 MEDALLION DR, MENDOTA HEIGHTS, MN, 551201220
|
Plan administrator’s name and address
| Administrator’s EIN |
350472300 |
| Plan administrator’s name |
LINCOLN NATIONAL LIFE INSURANCE COMPANY |
| Plan administrator’s
address |
8801 INDIAN HILLS DR, OMAHA, NE, 681144059 |
| Administrator’s telephone number |
8004232765 |
Number of participants as of the end of the plan year
| Active participants |
122 |
| Retired or separated participants receiving
benefits |
1 |
| 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 |
2017-07-12 |
| Name of individual signing |
KIM WAGNER |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
LONG TERM DISABILITY
|
2016
|
411400806
|
2017-07-12
|
MAYFLOWER DISTRIBUTING
|
122
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
502
|
| Effective date of plan |
2016-01-01
|
| Business code |
424990
|
| Sponsor’s telephone number |
6514682081
|
| Plan sponsor’s mailing address |
1155 MEDALLION DR, MENDOTA HEIGHTS, MN, 551201220
|
| Plan sponsor’s
address |
1155 MEDALLION DR, MENDOTA HEIGHTS, MN, 551201220
|
Plan administrator’s name and address
| Administrator’s EIN |
231503749 |
| Plan administrator’s name |
CIGNA GROUP INSURANCE |
| Plan administrator’s
address |
PO BOX 20643, LEHIGH VALLEY, PA, 180020643 |
Number of participants as of the end of the plan year
| Active participants |
122 |
| Retired or separated participants receiving
benefits |
1 |
| Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
Signature of
| Role |
Plan administrator |
| Date |
2017-07-12 |
| Name of individual signing |
KIM WAGNER |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
