ANTIOCH TIRE INC METLIFE PLAN 2015
|
2015
|
363878545
|
2017-03-06
|
ANTIOCH TIRE INC.
|
447
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2015-10-01
|
Business code |
441300
|
Sponsor’s telephone number |
2242654070
|
Plan
sponsor’s DBA name |
TREDROC TIRE SERVICES
|
Plan sponsor’s mailing address |
2450 LUNT AVE, ELK GROVE VILLAGE, IL, 600075612
|
Plan sponsor’s
address |
2450 LUNT AVE, ELK GROVE VILLAGE, IL, 600075612
|
Number of participants as of the end of the plan year
Active participants |
383 |
Retired or separated participants receiving
benefits |
1 |
Signature of
Role |
Plan administrator |
Date |
2017-03-06 |
Name of individual signing |
MARY HELS-JAGER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
ANTIOCH TIRE INC. HEALTH INSURANCE PLAN
|
2015
|
362739571
|
2017-03-06
|
ANTIOCH TIRE, INC.
|
497
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2015-10-01
|
Business code |
441300
|
Sponsor’s telephone number |
2242654070
|
Plan
sponsor’s DBA name |
TREDROC TIRE SERVICES
|
Plan sponsor’s mailing address |
2450 LUNT AVE, ELK GROVE VILLAGE, IL, 600075612
|
Plan sponsor’s
address |
2450 LUNT AVE, ELK GROVE VILLAGE, IL, 600075612
|
Number of participants as of the end of the plan year
Active participants |
247 |
Retired or separated participants receiving
benefits |
1 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2017-03-06 |
Name of individual signing |
MARY HELS-JAGER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
UNITEDHEALTHCARE HEALTH PLAN
|
2014
|
363878545
|
2016-03-04
|
ANTIOCH TIRE, INC.
|
509
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2014-10-01
|
Business code |
441300
|
Sponsor’s telephone number |
2242654070
|
Plan
sponsor’s DBA name |
TREDROC TIRE SERICES
|
Plan sponsor’s mailing address |
2450 LUNT AVENUE, ELK GROVE VILLAGE, IL, 60007
|
Plan sponsor’s
address |
2450 LUNT AVENUE, ELK GROVE VILLAGE, IL, 60007
|
Number of participants as of the end of the plan year
Active participants |
497 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
Number of
participants
with
account balances as of the end of the plan year |
0 |
Number of participants that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
0 |
Signature of
Role |
Plan administrator |
Date |
2016-03-04 |
Name of individual signing |
MARY HELS-JAGER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
ANTIOCH TIRE, INC. AND CBA TIRE INC HEALTH AND WELFARE PLAN
|
2013
|
362739571
|
2015-01-30
|
ANTIOCH TIRE, INC.
|
169
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2013-10-01
|
Business code |
441300
|
Sponsor’s telephone number |
2242654070
|
Plan
sponsor’s DBA name |
TREDROC TIRE SERVICES
|
Plan sponsor’s mailing address |
2450 LUNT AVENUE, ELK GROVE VILLAGE, IL, 60007
|
Plan sponsor’s
address |
2450 LUNT AVENUE, ELK GROVE VILLAGE, IL, 60007
|
Number of participants as of the end of the plan year
Active participants |
509 |
Retired or separated participants receiving
benefits |
2 |
Signature of
Role |
Plan administrator |
Date |
2015-01-30 |
Name of individual signing |
MARY HELS-JAGER |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2015-01-30 |
Name of individual signing |
MARY HELS-JAGER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CBA TIRE INC HEALTH AND WELFARE PLAN
|
2013
|
363878545
|
2014-06-04
|
ANTIOCH TIRE INC.
|
1136
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2013-01-01
|
Business code |
441300
|
Sponsor’s telephone number |
2242654070
|
Plan
sponsor’s DBA name |
TREDROC TIRE SERVICES
|
Plan sponsor’s mailing address |
2450 LUNT AVENUE, ELK GROVE VILLAGE, IL, 60007
|
Plan sponsor’s
address |
2450 LUNT AVENUE, ELK GROVE VILLAGE, IL, 60007
|
Number of participants as of the end of the plan year
Active participants |
671 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2014-06-04 |
Name of individual signing |
MARY HELS-JAGER |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2014-06-04 |
Name of individual signing |
MARY HELS-JAGER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
ANTIOCH TIRE SERVICES LIFE AND ADD
|
2013
|
363878545
|
2014-06-13
|
ANTIOCH TIRE INC.
|
169
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
2013-03-01
|
Business code |
441300
|
Sponsor’s telephone number |
2242654070
|
Plan
sponsor’s DBA name |
TREDROC TIRE SERVICES
|
Plan sponsor’s mailing address |
2450 LUNT AVENUE, ELK GROVE VILLAGE, IL, 60007
|
Plan sponsor’s
address |
2450 LUNT AVENUE, ELK GROVE VILLAGE, IL, 60007
|
Number of participants as of the end of the plan year
Active participants |
169 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2014-06-13 |
Name of individual signing |
MARY HELS-JAGER |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2014-06-13 |
Name of individual signing |
MARY HELS-JAGER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CBA TIRE HEALTH AND WELFARE PLAN
|
2009
|
363878545
|
2010-07-23
|
ANTIOCH TIRE, INC.
|
1136
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2000-09-01
|
Business code |
441300
|
Sponsor’s telephone number |
2242654070
|
Plan sponsor’s mailing address |
2450 LUNT AVE., ELK GROVE VILLAGE, IL, 60007
|
Plan sponsor’s
address |
2450 LUNT AVE., ELK GROVE VILLAGE, IL, 60007
|
Plan administrator’s name and address
Administrator’s EIN |
363878545 |
Plan administrator’s name |
ANTIOCH TIRE, INC. |
Plan administrator’s
address |
2450 LUNT AVE., ELK GROVE VILLAGE, IL, 60007 |
Administrator’s telephone number |
2242654070 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2010-07-23 |
Name of individual signing |
GLEN PARKS |
Valid signature |
Filed with authorized/valid electronic signature |
|
|