TEE JAY CENTRAL INC EMPLOYEE GROUP HEALTH PLAN
|
2017
|
363794651
|
2018-07-30
|
TEE JAY CENTRAL INC
|
15
|
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2014-01-01
|
Business code |
238290
|
Sponsor’s telephone number |
3097473247
|
Plan sponsor’s
address |
P O BOX 130, GRIDLEY, IL, 617440130
|
Plan administrator’s name and address
Administrator’s EIN |
431625757 |
Plan administrator’s name |
ALLIED NATIONAL INC |
Plan administrator’s
address |
P O BOX 29187, SHAWNEE MISSION, KS, 662079187 |
Administrator’s telephone number |
8008257531 |
Signature of
Role |
Plan administrator |
Date |
2018-07-30 |
Name of individual signing |
JAMES ZALESIAK |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Name of individual signing |
JAMES ZALESIAK |
|
|
TEE JAY CENTRAL INC EMPLOYEE GROUP HEALTH PLAN
|
2017
|
363794651
|
2018-08-03
|
TEE JAY CENTRAL INC
|
15
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2014-01-01
|
Business code |
238290
|
Sponsor’s telephone number |
3097473247
|
Plan sponsor’s
address |
P O BOX 130, GRIDLEY, IL, 617440130
|
Plan administrator’s name and address
Administrator’s EIN |
431625757 |
Plan administrator’s name |
ALLIED NATIONAL INC |
Plan administrator’s
address |
P O BOX 29187, SHAWNEE MISSION, KS, 662079187 |
Administrator’s telephone number |
8008257531 |
Signature of
Role |
Plan administrator |
Date |
2018-08-03 |
Name of individual signing |
JAMES ZALESIAK |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-08-03 |
Name of individual signing |
JAMES ZALESIAK |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
TEE JAY CENTRAL INC EMPLOYEE GROUP HEALTH PLAN
|
2016
|
363794651
|
2017-07-07
|
TEE JAY CENTRAL INC
|
15
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2014-01-01
|
Business code |
238290
|
Sponsor’s telephone number |
3097473247
|
Plan sponsor’s
address |
P O BOX 130, GRIDLEY, IL, 617440130
|
Plan administrator’s name and address
Administrator’s EIN |
431625757 |
Plan administrator’s name |
ALLIED NATIONAL INC |
Plan administrator’s
address |
P O BOX 29187, SHAWNEE MISSION, KS, 662079187 |
Administrator’s telephone number |
8008257531 |
Signature of
Role |
Plan administrator |
Date |
2017-07-07 |
Name of individual signing |
JAMES ZALESIAK |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2017-07-07 |
Name of individual signing |
JAMES ZALESIAK |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
TEE JAY CENTRAL INC EMPLOYEE GROUP HEALTH PLAN
|
2015
|
363794651
|
2016-07-15
|
TEE JAY CENTRAL INC
|
12
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2014-01-01
|
Business code |
238290
|
Sponsor’s telephone number |
3097473247
|
Plan sponsor’s
address |
P O BOX 130, GRIDLEY, IL, 617440130
|
Plan administrator’s name and address
Administrator’s EIN |
431625757 |
Plan administrator’s name |
ALLIED NATIONAL INC |
Plan administrator’s
address |
P O BOX 29187, SHAWNEE MISSION, KS, 662079187 |
Administrator’s telephone number |
8008257531 |
Signature of
Role |
Plan administrator |
Date |
2016-07-15 |
Name of individual signing |
JAMES ZALESIAK |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2016-07-15 |
Name of individual signing |
JAMES ZALESIAK |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
TEE JAY CENTRAL INC EMPLOYEE GROUP HEALTH PLAN
|
2014
|
363794651
|
2015-07-21
|
TEE JAY CENTRAL INC
|
0
|
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2014-01-01
|
Business code |
238290
|
Sponsor’s telephone number |
3097473247
|
Plan sponsor’s
address |
P O BOX 130, GRIDLEY, IL, 617440130
|
Plan administrator’s name and address
Administrator’s EIN |
431625757 |
Plan administrator’s name |
ALLIED NATIONAL INC |
Plan administrator’s
address |
P O BOX 29187, SHAWNEE MISSION, KS, 662079187 |
Administrator’s telephone number |
8008257531 |
Signature of
Role |
Plan administrator |
Date |
2015-07-21 |
Name of individual signing |
JAMES ZALESIAK |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2015-07-21 |
Name of individual signing |
JAMES ZALESIAK |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
TEE JAY CENTRAL INC EMPLOYEE GROUP HEALTH PLAN
|
2014
|
363794651
|
2015-07-22
|
TEE JAY CENTRAL INC
|
0
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2014-01-01
|
Business code |
238290
|
Sponsor’s telephone number |
3097473247
|
Plan sponsor’s
address |
P O BOX 130, GRIDLEY, IL, 617440130
|
Plan administrator’s name and address
Administrator’s EIN |
431625757 |
Plan administrator’s name |
ALLIED NATIONAL INC |
Plan administrator’s
address |
P O BOX 29187, SHAWNEE MISSION, KS, 662079187 |
Administrator’s telephone number |
8008257531 |
Signature of
Role |
Plan administrator |
Date |
2015-07-21 |
Name of individual signing |
JAMES ZALESIAK |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2015-07-21 |
Name of individual signing |
JAMES ZALESIAK |
Valid signature |
Filed with authorized/valid electronic signature |
|
|