HOSPITAL SURGICAL AND MEDICAL PLAN
|
2018
|
223139841
|
2019-04-24
|
WESLEY GARDENS CORPORATION
|
41
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2018-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
5852412100
|
Plan sponsor’s mailing address |
3 UPTON PARK, ROCHESTER, NY, 146071500
|
Plan sponsor’s
address |
3 UPTON PARK, ROCHESTER, NY, 146071500
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2019-04-24 |
Name of individual signing |
FRANCIS DAMICO |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2019-04-24 |
Name of individual signing |
FRANCIS DAMICO |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LIFE ACCIDENTAL DEATH AND DISMEMBERMENT PLAN
|
2018
|
223139841
|
2019-04-24
|
WESLEY GARDENS CORPORATION
|
112
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1985-06-01
|
Business code |
623000
|
Sponsor’s telephone number |
5852412100
|
Plan sponsor’s mailing address |
3 UPTON PARK, ROCHESTER, NY, 146071500
|
Plan sponsor’s
address |
3 UPTON PARK, ROCHESTER, NY, 146071500
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2019-04-24 |
Name of individual signing |
FRANCIS DAMICO |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2019-04-24 |
Name of individual signing |
FRANCIS DAMICO |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
DENTAL PLAN
|
2018
|
223139841
|
2019-04-24
|
WESLEY GARDENS CORPORATION
|
76
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1987-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
5852412100
|
Plan sponsor’s mailing address |
3 UPTON PARK, ROCHESTER, NY, 146071500
|
Plan sponsor’s
address |
3 UPTON PARK, ROCHESTER, NY, 146071500
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2019-04-24 |
Name of individual signing |
FRANCIS DAMICO |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2019-04-24 |
Name of individual signing |
FRANCIS DAMICO |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
HOSPITAL SURGICAL AND MEDICAL PLAN
|
2018
|
223139841
|
2019-04-24
|
WESLEY GARDENS CORPORATION
|
29
|
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2018-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
5852412100
|
Plan sponsor’s mailing address |
3 UPTON PARK, ROCHESTER, NY, 146071500
|
Plan sponsor’s
address |
3 UPTON PARK, ROCHESTER, NY, 146071500
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2019-04-24 |
Name of individual signing |
FRANCIS DAMICO |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2019-04-24 |
Name of individual signing |
FRANCIS DAMICO |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
HOSPITAL SURGICAL AND MEDICAL PLAN
|
2017
|
223139841
|
2018-03-25
|
WESLEY GARDENS CORPORATION
|
21
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2017-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
5852412100
|
Plan sponsor’s mailing address |
3 UPTON PARK, ROCHESTER, NY, 146071500
|
Plan sponsor’s
address |
3 UPTON PARK, ROCHESTER, NY, 146071500
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2018-03-25 |
Name of individual signing |
FRANCIS DAMICO |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-03-25 |
Name of individual signing |
FRANCIS DAMICO |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
HOSPITAL SURGICAL AND MEDICAL PLAN
|
2017
|
223139841
|
2018-03-25
|
WESLEY GARDENS CORPORATION
|
88
|
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
1963-11-15
|
Business code |
623000
|
Sponsor’s telephone number |
5852412100
|
Plan sponsor’s mailing address |
3 UPTON PARK, ROCHESTER, NY, 146071500
|
Plan sponsor’s
address |
3 UPTON PARK, ROCHESTER, NY, 146071500
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2018-03-25 |
Name of individual signing |
FRANCIS DAMICO |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-03-25 |
Name of individual signing |
FRANCIS DAMICO |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LIFE ACCIDENTAL DEATH AND DISMEMBERMENT PLAN
|
2017
|
223139841
|
2018-03-25
|
WESLEY GARDENS CORPORATION
|
117
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2017-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
5852412100
|
Plan sponsor’s mailing address |
3 UPTON PARK, ROCHESTER, NY, 146071500
|
Plan sponsor’s
address |
3 UPTON PARK, ROCHESTER, NY, 146071500
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2018-03-25 |
Name of individual signing |
FRANCIS DAMICO |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-03-25 |
Name of individual signing |
FRANCIS DAMICO |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
DENTAL PLAN
|
2017
|
223139841
|
2018-03-25
|
WESLEY GARDENS CORPORATION
|
86
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1987-01-01
|
Business code |
623000
|
Sponsor’s telephone number |
5852412100
|
Plan sponsor’s mailing address |
3 UPTON PARK, ROCHESTER, NY, 146071500
|
Plan sponsor’s
address |
3 UPTON PARK, ROCHESTER, NY, 146071500
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2018-03-25 |
Name of individual signing |
FRANCIS DAMICO |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-03-25 |
Name of individual signing |
FRANCIS DAMICO |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
HOSPITAL SURGICAL AND MEDICAL PLAN
|
2016
|
223139841
|
2017-03-31
|
WESLEY GARDENS CORPORATION
|
143
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
1963-11-15
|
Business code |
623000
|
Sponsor’s telephone number |
5852412100
|
Plan sponsor’s mailing address |
3 UPTON PARK, ROCHESTER, NY, 146071500
|
Plan sponsor’s
address |
3 UPTON PARK, ROCHESTER, NY, 146071500
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2017-03-31 |
Name of individual signing |
FRANCIS DAMICO |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2017-03-31 |
Name of individual signing |
FRANCIS DAMICO |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LIFE ACCIDENTAL DEATN AND DISMEMBERMENT PLAN
|
2016
|
223139841
|
2017-03-31
|
WESLEY GARDENS CORPORATION
|
137
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1985-06-01
|
Business code |
623000
|
Sponsor’s telephone number |
5852412100
|
Plan sponsor’s mailing address |
3 UPTON PARK, ROCHESTER, NY, 146071500
|
Plan sponsor’s
address |
3 UPTON PARK, ROCHESTER, NY, 146071500
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2017-03-31 |
Name of individual signing |
FRANCIS DAMICO |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2017-03-31 |
Name of individual signing |
FRANCIS DAMICO |
Valid signature |
Filed with authorized/valid electronic signature |
|
|