|
KB TRUCK REPAIR INC. MEDOVA LIFESTYLE HEALTH PLAN
|
2021
|
371398467
|
2023-06-30
|
KB TRUCK REPAIR INC.
|
0
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2020-12-01
|
| Business code |
811110
|
| Sponsor’s telephone number |
6187492076
|
| Plan sponsor’s
address |
2358 HIGHWAY 111, PONTOON BEACH, IL, 620406677
|
Plan administrator’s name and address
| Administrator’s EIN |
200200514 |
| Plan administrator’s name |
RECEIVERSHIP MANAGEMENT INC |
| Plan administrator’s
address |
510 HOSPITAL DR STE 490, MADISON, TN, 371155049 |
| Administrator’s telephone number |
6153700051 |
Signature of
| Role |
Plan administrator |
| Date |
2023-06-30 |
| Name of individual signing |
ROBERT MOORE |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
KB TRUCK REPAIR INC. MEDOVA LIFESTYLE HEALTH PLAN
|
2020
|
371398467
|
2022-09-02
|
KB TRUCK REPAIR INC.
|
17
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2020-12-01
|
| Business code |
811110
|
| Sponsor’s telephone number |
6187497276
|
| Plan sponsor’s
address |
2358 HIGHWAY 111, PONTOON BEACH, IL, 620406677
|
Plan administrator’s name and address
| Administrator’s EIN |
200200514 |
| Plan administrator’s name |
RECEIVERSHIP MANAGEMENT INC |
| Plan administrator’s
address |
510 HOSPITAL DR STE 490, MADISON, TN, 371155049 |
| Administrator’s telephone number |
6153700051 |
Signature of
| Role |
Plan administrator |
| Date |
2022-08-31 |
| Name of individual signing |
ROBERT MOORE |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
KB TRUCK REPAIR 401(K) PLAN
|
2015
|
371398467
|
2016-09-05
|
KB TRUCK REPAIR INC.
|
12
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2012-01-01
|
| Business code |
811110
|
| Sponsor’s telephone number |
6187972076
|
| Plan sponsor’s
address |
2358 HWY 111, PONTOON BEACH, IL, 62040
|
Signature of
| Role |
Plan administrator |
| Date |
2016-09-05 |
| Name of individual signing |
ROBERT B. KETROW |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
KB TRUCK REPAIR 401(K) PLAN
|
2014
|
371398467
|
2015-09-22
|
KB TRUCK REPAIR INC.
|
14
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2012-01-01
|
| Business code |
811110
|
| Sponsor’s telephone number |
6187972076
|
| Plan sponsor’s
address |
2358 HWY 111, PONTOON BEACH, IL, 62040
|
Signature of
| Role |
Plan administrator |
| Date |
2015-09-22 |
| Name of individual signing |
ROBERT B. KETROW |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
KB TRUCK REPAIR 401(K) PLAN
|
2013
|
371398467
|
2014-10-10
|
KB TRUCK REPAIR INC.
|
13
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2012-01-01
|
| Business code |
811110
|
| Sponsor’s telephone number |
6187972076
|
| Plan sponsor’s
address |
2358 HWY 111, PONTOON BEACH, IL, 62040
|
Signature of
| Role |
Plan administrator |
| Date |
2014-10-10 |
| Name of individual signing |
ROBERT B. KETROW |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
KB TRUCK REPAIR 401(K) PLAN
|
2012
|
371398467
|
2013-07-30
|
KB TRUCK REPAIR INC.
|
12
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2012-01-01
|
| Business code |
811110
|
| Sponsor’s telephone number |
6187972076
|
| Plan sponsor’s
address |
2358 HWY 111, PONTOON BEACH, IL, 62040
|
Signature of
| Role |
Plan administrator |
| Date |
2013-07-30 |
| Name of individual signing |
ROBERT B. KETROW |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
