CHENEY BROTHERS, INC. 2015 MEDICAL, DENTAL & STOP LOSS
|
2015
|
591003104
|
2016-06-23
|
CHENEY BROTHERS, INC.
|
2318
|
|
File |
View Page
|
Three-digit plan number (PN) |
901
|
Effective date of plan |
2004-09-01
|
Business code |
424400
|
Sponsor’s telephone number |
5618454700
|
Plan sponsor’s mailing address |
1 CHENEY WAY, RIVIERA BEACH, FL, 334047000
|
Plan sponsor’s
address |
1 CHENEY WAY, RIVIERA BEACH, FL, 334047000
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2016-06-22 |
Name of individual signing |
MICHAEL SULLIVAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2016-06-22 |
Name of individual signing |
MICHAEL SULLIVAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CHENEY BROTHERS INC EMPLOYEE ANCILLARY BENEFIT PLAN
|
2015
|
591003104
|
2016-06-24
|
CHENEY BROTHERS, INC.
|
2318
|
|
File |
View Page
|
Three-digit plan number (PN) |
801
|
Effective date of plan |
2004-09-01
|
Business code |
424400
|
Sponsor’s telephone number |
5618454700
|
Plan sponsor’s mailing address |
1 CHENEY WAY, RIVIERA BEACH, FL, 334047000
|
Plan sponsor’s
address |
1 CHENEY WAY, RIVIERA BEACH, FL, 334047000
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2016-06-24 |
Name of individual signing |
MICHAEL SULLIVAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2016-06-24 |
Name of individual signing |
MICHAEL SULLIVAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CHENEY BROTHERS, INC. MEDICAL, DENTAL, STOP LOSS
|
2014
|
591003104
|
2015-07-06
|
CHENEY BROTHERS, INC
|
2099
|
|
File |
View Page
|
Three-digit plan number (PN) |
801
|
Effective date of plan |
2004-09-01
|
Business code |
424400
|
Sponsor’s telephone number |
5618454700
|
Plan sponsor’s mailing address |
ONE CHENEY WAY, RIVIERA BEACH, FL, 33404
|
Plan sponsor’s
address |
ONE CHENEY WAY, RIVIERA BEACH, FL, 33404
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2015-07-06 |
Name of individual signing |
MICHAEL SULLIVAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2015-07-06 |
Name of individual signing |
MICHAEL SULLIVAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CHENEY BROTHERS, INC. MEDICAL, DENTAL, STOP LOSS
|
2014
|
591003104
|
2015-07-06
|
CHENEY BROTHERS, INC
|
2099
|
|
File |
View Page
|
Three-digit plan number (PN) |
901
|
Effective date of plan |
2004-09-01
|
Business code |
424400
|
Sponsor’s telephone number |
5618454700
|
Plan sponsor’s mailing address |
ONE CHENEY WAY, RIVIERA BEACH, FL, 33404
|
Plan sponsor’s
address |
ONE CHENEY WAY, RIVIERA BEACH, FL, 33404
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2015-07-06 |
Name of individual signing |
MICHAEL SULLIVAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2015-07-06 |
Name of individual signing |
MICHAEL SULLIVAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CHENEY BROTHERS, INC. LIFE, ACCIDENTAL DEATH, DISABILITY
|
2013
|
591003104
|
2014-06-03
|
CHENEY BROTHERS, INC.
|
1367
|
|
File |
View Page
|
Three-digit plan number (PN) |
801
|
Effective date of plan |
2005-06-01
|
Business code |
424400
|
Sponsor’s telephone number |
5618454700
|
Plan sponsor’s mailing address |
ONE CHENEY WAY, RIVIERA BEACH, FL, 334047000
|
Plan sponsor’s
address |
ONE CHENEY WAY, RIVIERA BEACH, FL, 334047000
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2014-06-03 |
Name of individual signing |
MICHAEL SULLIVAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2014-06-03 |
Name of individual signing |
MICHAEL SULLIVAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CHENEY BROTHERS, INC. MEDICAL, DENTAL, STOP LOSS
|
2013
|
591003104
|
2014-06-03
|
CHENEY BROTHERS, INC.
|
1162
|
|
File |
View Page
|
Three-digit plan number (PN) |
901
|
Effective date of plan |
2004-09-01
|
Business code |
424400
|
Sponsor’s telephone number |
5618454700
|
Plan sponsor’s mailing address |
ONE CHENEY WAY, RIVIERA BEACH, FL, 334047000
|
Plan sponsor’s
address |
ONE CHENEY WAY, RIVIERA BEACH, FL, 334047000
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2014-06-03 |
Name of individual signing |
MICHAEL SULLIVAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2014-06-03 |
Name of individual signing |
MICHAEL SULLIVAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CHENEY BROTHERS, INC. LIFE, ACCIDENTAL DEATH, DISABILITY
|
2012
|
591003104
|
2013-07-02
|
CHENEY BROTHERS, INC.
|
1322
|
|
File |
View Page
|
Three-digit plan number (PN) |
801
|
Effective date of plan |
2005-06-01
|
Business code |
424400
|
Sponsor’s telephone number |
5618454700
|
Plan sponsor’s mailing address |
ONE CHENEY WAY, RIVIERA BEACH, FL, 33404
|
Plan sponsor’s
address |
ONE CHENEY WAY, RIVIERA BEACH, FL, 33404
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2013-07-02 |
Name of individual signing |
MICHAEL SULLIVAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-07-02 |
Name of individual signing |
MICHAEL SULLIVAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CHENEY BROTHERS, INC. MEDICAL, DENTAL, STOP LOSS
|
2012
|
591003104
|
2013-07-02
|
CHENEY BROTHERS INC
|
1172
|
|
File |
View Page
|
Three-digit plan number (PN) |
901
|
Effective date of plan |
2004-09-01
|
Business code |
424400
|
Sponsor’s telephone number |
5618454700
|
Plan sponsor’s mailing address |
ONE CHENEY WAY, RIVIERA BEACH, FL, 334047000
|
Plan sponsor’s
address |
ONE CHENEY WAY, RIVIERA BEACH, FL, 334047000
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2013-07-02 |
Name of individual signing |
MICHAEL SULLIVAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-07-02 |
Name of individual signing |
MICHAEL SULLIVAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CHENEY BROTHERS, INC. LIFE, ACCIDENTAL DEATH, DISABILITY
|
2011
|
591003104
|
2012-06-28
|
CHENEY BROTHERS, INC.
|
1447
|
|
File |
View Page
|
Three-digit plan number (PN) |
801
|
Effective date of plan |
2005-06-01
|
Business code |
424400
|
Sponsor’s telephone number |
5618454700
|
Plan sponsor’s mailing address |
ONE CHENEY WAY, RIVIERA BEACH, FL, 33404
|
Plan sponsor’s
address |
ONE CHENEY WAY, RIVIERA BEACH, FL, 33404
|
Plan administrator’s name and address
Administrator’s EIN |
591003104 |
Plan administrator’s name |
CHENEY BROTHERS, INC. |
Plan administrator’s
address |
ONE CHENEY WAY, RIVIERA BEACH, FL, 33404 |
Administrator’s telephone number |
5618454700 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2012-06-28 |
Name of individual signing |
MICHAEL SULLIVAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CHENEY BROTHERS, INC. MEDICAL, DENTAL, STOP LOSS
|
2011
|
591003104
|
2012-06-28
|
CHENEY BROTHERS INC
|
1182
|
|
File |
View Page
|
Three-digit plan number (PN) |
901
|
Effective date of plan |
2004-09-01
|
Business code |
424400
|
Sponsor’s telephone number |
5618454700
|
Plan sponsor’s mailing address |
ONE CHENEY WAY, RIVIERA BEACH, FL, 334047000
|
Plan sponsor’s
address |
ONE CHENEY WAY, RIVIERA BEACH, FL, 334047000
|
Plan administrator’s name and address
Administrator’s EIN |
591003104 |
Plan administrator’s name |
CHENEY BROTHERS INC |
Plan administrator’s
address |
ONE CHENEY WAY, RIVIERA BEACH, FL, 334047000 |
Administrator’s telephone number |
5618454700 |
Number of participants as of the end of the plan year
Active participants |
1146 |
Retired or separated participants receiving
benefits |
3 |
Other
retired or separated participants entitled to future benefits |
23 |
Signature of
Role |
Plan administrator |
Date |
2012-06-28 |
Name of individual signing |
MICHAEL SULLIVAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|