FIRSTSOURCE ADVANTAGE, LLC EMPLOYEE HEALTH BENEFIT PLAN
|
2023
|
161479585
|
2024-10-01
|
FIRSTSOURCE ADVANTAGE, LLC
|
135
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1997-04-17
|
Business code |
561440
|
Sponsor’s telephone number |
7165644412
|
Plan sponsor’s mailing address |
205 BRYANT WOODS SOUTH, AMHERST, NY, 14228
|
Plan sponsor’s
address |
205 BRYANT WOODS SOUTH, AMHERST, NY, 14228
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2024-09-30 |
Name of individual signing |
LINDSAY SMITH |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2024-09-30 |
Name of individual signing |
LINDSAY SMITH |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
FIRSTSOURCE ADVANTAGE, LLC EMPLOYEE HEALTH BENEFIT PLAN
|
2022
|
161479585
|
2023-09-28
|
FIRSTSOURCE ADVANTAGE, LLC
|
352
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1997-04-17
|
Business code |
561440
|
Sponsor’s telephone number |
7165644412
|
Plan sponsor’s mailing address |
205 BRYANT WOODS SOUTH, AMHERST, NY, 14228
|
Plan sponsor’s
address |
205 BRYANT WOODS SOUTH, AMHERST, NY, 14228
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2023-09-27 |
Name of individual signing |
JONATHAN BAUSCHER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
FIRSTSOURCE ADVANTAGE, LLC EMPLOYEE HEALTH BENEFIT PLAN
|
2021
|
161479585
|
2022-09-20
|
FIRSTSOURCE ADVANTAGE, LLC
|
450
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1997-04-17
|
Business code |
561440
|
Sponsor’s telephone number |
7165644412
|
Plan sponsor’s mailing address |
205 BRYANT WOODS SOUTH, AMHERST, NY, 14228
|
Plan sponsor’s
address |
205 BRYANT WOODS SOUTH, AMHERST, NY, 14228
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2022-09-20 |
Name of individual signing |
JONATHAN BAUSCHER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
FIRSTSOURCE ADVANTAGE, LLC EMPLOYEE HEALTH BENEFIT PLAN
|
2020
|
161479585
|
2021-10-04
|
FIRSTSOURCE ADVANTAGE, LLC
|
428
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1997-04-17
|
Business code |
561440
|
Sponsor’s telephone number |
7165644412
|
Plan sponsor’s mailing address |
205 BRYANT WOODS SOUTH, AMHERST, NY, 14228
|
Plan sponsor’s
address |
205 BRYANT WOODS SOUTH, AMHERST, NY, 14228
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2021-10-04 |
Name of individual signing |
JONATHAN BAUSCHER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
FIRSTSOURCE ADVANTAGE, LLC EMPLOYEE HEALTH BENEFIT PLAN
|
2019
|
161479585
|
2020-09-03
|
FIRSTSOURCE ADVANTAGE, LLC
|
401
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1997-04-17
|
Business code |
561440
|
Sponsor’s telephone number |
7165644412
|
Plan sponsor’s mailing address |
205 BRYANT WOODS SOUTH, AMHERST, NY, 14228
|
Plan sponsor’s
address |
205 BRYANT WOODS SOUTH, AMHERST, NY, 14228
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2020-09-02 |
Name of individual signing |
JONATHAN BAUSCHER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
FIRSTSOURCE ADVANTAGE, LLC EMPLOYEE HEALTH BENEFIT PLAN
|
2018
|
161479585
|
2019-10-04
|
FIRSTSOURCE ADVANTAGE, LLC
|
453
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1997-04-17
|
Business code |
561440
|
Sponsor’s telephone number |
7165644412
|
Plan sponsor’s mailing address |
205 BRYANT WOODS SOUTH, AMHERST, NY, 14228
|
Plan sponsor’s
address |
205 BRYANT WOODS SOUTH, AMHERST, NY, 14228
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2019-10-04 |
Name of individual signing |
JONATHAN BAUSCHER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
FIRSTSOURCE ADVANTAGE, LLC EMPLOYEE HEALTH BENEFIT PLAN
|
2017
|
161479585
|
2018-10-01
|
FIRSTSOURCE ADVANTAGE, LLC
|
594
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1997-04-17
|
Business code |
561440
|
Sponsor’s telephone number |
7165644412
|
Plan sponsor’s mailing address |
205 BRYANT WOODS SOUTH, AMHERST, NY, 14228
|
Plan sponsor’s
address |
205 BRYANT WOODS SOUTH, AMHERST, NY, 14228
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2018-09-24 |
Name of individual signing |
JONATHAN BAUSCHER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
FIRSTSOURCE ADVANTAGE, LLC EMPLOYEE HEALTH BENEFIT PLAN
|
2016
|
161479585
|
2017-10-24
|
FIRSTSOURCE ADVANTAGE, LLC
|
470
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1997-04-17
|
Business code |
561440
|
Sponsor’s telephone number |
7165644412
|
Plan sponsor’s mailing address |
205 BRYANT WOODS SOUTH, AMHERST, NY, 14228
|
Plan sponsor’s
address |
205 BRYANT WOODS SOUTH, AMHERST, NY, 14228
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2017-10-24 |
Name of individual signing |
LAURA PARRISH |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2017-10-24 |
Name of individual signing |
LAURA PARRISH |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
FIRSTSOURCE ADVANTAGE, LLC EMPLOYEE HEALTH BENEFIT PLAN
|
2016
|
161479585
|
2017-10-12
|
FIRSTSOURCE ADVANTAGE, LLC
|
470
|
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1997-04-17
|
Business code |
561440
|
Sponsor’s telephone number |
7165644412
|
Plan sponsor’s mailing address |
205 BRYANT WOODS SOUTH, AMHERST, NY, 14228
|
Plan sponsor’s
address |
205 BRYANT WOODS SOUTH, AMHERST, NY, 14228
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2017-10-12 |
Name of individual signing |
LAURA PARRISH |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
FIRSTSOURCE ADVANTAGE, LLC EMPLOYEE HEALTH BENEFIT PLAN
|
2015
|
161479585
|
2016-10-12
|
FIRSTSOURCE ADVANTAGE, LLC
|
434
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1997-04-17
|
Business code |
561440
|
Sponsor’s telephone number |
7165644412
|
Plan sponsor’s mailing address |
205 BRYANT WOODS SOUTH, AMHERST, NY, 14228
|
Plan sponsor’s
address |
205 BRYANT WOODS SOUTH, AMHERST, NY, 14228
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2016-10-12 |
Name of individual signing |
JONATHAN BAUSCHER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|