A. L. JACOBSEN FUNERAL HOME, INC. 401(K) PROFIT SHARING PLAN
|
2019
|
110915740
|
2020-04-10
|
A L JACOBSEN FUNERAL HOME INC
|
7
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
1999-05-13
|
Business code |
812210
|
Sponsor’s telephone number |
6314232185
|
Plan sponsor’s
address |
1380 NEW YORK AVENUE, HUNTINGTON STATION, NY, 11746
|
Signature of
Role |
Plan administrator |
Date |
2020-04-10 |
Name of individual signing |
BOB LAMONTE |
|
|
A. L. JACOBSEN FUNERAL HOME, INC. 401(K) PROFIT SHARING PLAN
|
2018
|
110915740
|
2019-07-15
|
A L JACOBSEN FUNERAL HOME INC
|
8
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
1999-05-13
|
Business code |
812210
|
Sponsor’s telephone number |
6314232185
|
Plan sponsor’s
address |
1380 NEW YORK AVENUE, HUNTINGTON STATION, NY, 11746
|
Signature of
Role |
Plan administrator |
Date |
2019-07-15 |
Name of individual signing |
SHAWN FIVES |
|
|
A. L. JACOBSEN FUNERAL HOME, INC. 401(K) PROFIT SHARING PLAN
|
2017
|
110915740
|
2018-06-11
|
A L JACOBSEN FUNERAL HOME INC
|
8
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
1999-05-13
|
Business code |
812210
|
Sponsor’s telephone number |
6314232185
|
Plan sponsor’s
address |
1380 NEW YORK AVENUE, HUNTINGTON STATION, NY, 11746
|
Signature of
Role |
Plan administrator |
Date |
2018-06-11 |
Name of individual signing |
SHAWN FIVES |
|
|
A. L. JACOBSEN FUNERAL HOME, INC. 401(K) PROFIT SHARING PLAN
|
2016
|
110915740
|
2017-06-22
|
A L JACOBSEN FUNERAL HOME INC
|
8
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
1999-05-13
|
Business code |
812210
|
Sponsor’s telephone number |
6314232185
|
Plan sponsor’s
address |
1380 NEW YORK AVENUE, HUNTINGTON STATION, NY, 11746
|
Signature of
Role |
Plan administrator |
Date |
2017-06-22 |
Name of individual signing |
SHAWN FIVES |
|
|
A. L. JACOBSEN FUNERAL HOME, INC. 401(K) PROFIT SHARING PLAN
|
2015
|
110915740
|
2016-06-29
|
A L JACOBSEN FUNERAL HOME INC
|
8
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
1999-05-13
|
Business code |
812210
|
Sponsor’s telephone number |
6314232185
|
Plan sponsor’s
address |
1380 NEW YORK AVENUE, HUNTINGTON STATION, NY, 11746
|
Signature of
Role |
Plan administrator |
Date |
2016-06-29 |
Name of individual signing |
SHAWN FIVES |
|
|
A. L. JACOBSEN FUNERAL HOME, INC. 401(K) PROFIT SHARING PLAN
|
2014
|
110915740
|
2015-05-28
|
A L JACOBSEN FUNERAL HOME INC
|
8
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
1999-05-13
|
Business code |
812210
|
Sponsor’s telephone number |
6314232185
|
Plan sponsor’s
address |
1380 NEW YORK AVENUE, HUNTINGTON STATION, NY, 11746
|
Signature of
Role |
Plan administrator |
Date |
2015-05-28 |
Name of individual signing |
SHAWN FIVES |
|
|
A. L. JACOBSEN FUNERAL HOME, INC. 401(K) PROFIT SHARING PLAN
|
2013
|
110915740
|
2014-06-26
|
A L JACOBSEN FUNERAL HOME INC
|
11
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
1999-05-13
|
Business code |
812210
|
Sponsor’s telephone number |
6314232185
|
Plan sponsor’s
address |
1380 NEW YORK AVENUE, HUNTINGTON STATION, NY, 11746
|
Signature of
Role |
Plan administrator |
Date |
2014-06-26 |
Name of individual signing |
SHAWN FIVES |
|
|
A L JACOBSEN FUNERAL HOME INC 401K PLAN
|
2011
|
110915740
|
2012-10-01
|
A L JACOBSEN FUNERAL HOME INC
|
6
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
1999-05-13
|
Business code |
812210
|
Sponsor’s telephone number |
6314232185
|
Plan sponsor’s
address |
1380 NEW YORK AVENUE, ATTN CHRISTIAN JACOBSEN, HUNTINGTON STATION, NY, 11746
|
Plan administrator’s name and address
Administrator’s EIN |
110915740 |
Plan administrator’s name |
A L JACOBSEN FUNERAL HOME INC |
Plan administrator’s
address |
1380 NEW YORK AVENUE, ATTN CHRISTIAN JACOBSEN, HUNTINGTON STATION, NY, 11746 |
Administrator’s telephone number |
6314232185 |
Signature of
Role |
Plan administrator |
Date |
2012-10-01 |
Name of individual signing |
CHRISTIAN JACOBSEN |
|
|
A. L. JACOBSEN FUNERAL HOME, INC. 401(K) PROFIT SHARING PLAN
|
2010
|
110915740
|
2011-10-04
|
A. L. JACOBSEN FUNERAL HOME, INC.
|
10
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
1996-01-01
|
Business code |
812210
|
Sponsor’s telephone number |
6314232185
|
Plan sponsor’s
address |
1380 NEW YORK AVENUE, HUNTINGTON STATION, NY, 11746
|
Plan administrator’s name and address
Administrator’s EIN |
110915740 |
Plan administrator’s name |
A. L. JACOBSEN FUNERAL HOME, INC. |
Plan administrator’s
address |
1380 NEW YORK AVENUE, HUNTINGTON STATION, NY, 11746 |
Administrator’s telephone number |
6314232185 |
Signature of
Role |
Plan administrator |
Date |
2011-08-18 |
Name of individual signing |
CHRISTIAN K. JACOBSEN |
|
|
A. L. JACOBSEN FUNERAL HOME, INC. 401(K) PROFIT SHARING PLAN
|
2010
|
110915740
|
2011-08-18
|
A. L. JACOBSEN FUNERAL HOME, INC.
|
10
|
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
1996-01-01
|
Business code |
812210
|
Sponsor’s telephone number |
6314232185
|
Plan sponsor’s
address |
1380 NEW YORK AVENUE, HUNTINGTON STATION, NY, 11746
|
Plan administrator’s name and address
Administrator’s EIN |
110915740 |
Plan administrator’s name |
A. L. JACOBSEN FUNERAL HOME, INC. |
Plan administrator’s
address |
1380 NEW YORK AVENUE, HUNTINGTON STATION, NY, 11746 |
Administrator’s telephone number |
6314232185 |
Signature of
Role |
Plan administrator |
Date |
2011-08-18 |
Name of individual signing |
CHRISTIAN K. JACOBSEN |
|
|