LONNIES TIRE & AUTO INC EMPLOYEE GROUP HEALTH PLAN
|
2018
|
203048591
|
2019-07-08
|
LONNIE'S TIRE & AUTO, INC
|
3
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2017-01-01
|
Business code |
811110
|
Sponsor’s telephone number |
6185668473
|
Plan sponsor’s
address |
1034 WEST MAIN STREET, MASCOUTAH, IL, 62258
|
Signature of
Role |
Plan administrator |
Date |
2019-07-08 |
Name of individual signing |
LONNIE CASEY |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2019-07-08 |
Name of individual signing |
LONNIE CASEY |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LONNIES TIRE & AUTO INC EMPLOYEE GROUP HEALTH PLAN
|
2017
|
203048591
|
2018-05-31
|
LONNIE'S TIRE & AUTO, INC
|
3
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2017-01-01
|
Business code |
811110
|
Sponsor’s telephone number |
6185668473
|
Plan sponsor’s
address |
1034 WEST MAIN STREET, MASCOUTAH, IL, 62258
|
Signature of
Role |
Plan administrator |
Date |
2018-05-30 |
Name of individual signing |
LONNIE CASEY |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-05-30 |
Name of individual signing |
LONNIE CASEY |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LONNIES TIRE & AUTO INC EMPLOYEE GROUP HEALTH PLAN
|
2016
|
203048591
|
2017-06-09
|
LONNIE'S TIRE & AUTO, INC
|
3
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2014-01-01
|
Business code |
811110
|
Sponsor’s telephone number |
6185668473
|
Plan sponsor’s
address |
1034 WEST MAIN STREET, MASCOUTAH, IL, 62258
|
Signature of
Role |
Plan administrator |
Date |
2017-06-05 |
Name of individual signing |
LONNIE CASEY |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2017-06-05 |
Name of individual signing |
LONNIE CASEY |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LONNIES TIRE & AUTO INC EMPLOYEE GROUP HEALTH PLAN
|
2015
|
203048591
|
2016-07-22
|
LONNIE'S TIRE & AUTO, INC
|
2
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2014-01-01
|
Business code |
811110
|
Sponsor’s telephone number |
6185668473
|
Plan sponsor’s
address |
1034 WEST MAIN STREET, MASCOUTAH, IL, 62258
|
Signature of
Role |
Plan administrator |
Date |
2016-07-22 |
Name of individual signing |
LONNIE CASEY |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2016-07-22 |
Name of individual signing |
LONNIE CASEY |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LONNIES TIRE AUTO INC EMPLOYEE GROUP HEALTH PLAN
|
2014
|
203048591
|
2015-07-27
|
LONNIE'S TIRE & AUTO, INC
|
0
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2014-01-01
|
Business code |
811110
|
Sponsor’s telephone number |
6185668473
|
Plan sponsor’s
address |
1034 WEST MAIN STREET, MASCOUTAH, IL, 62258
|
Signature of
Role |
Plan administrator |
Date |
2015-07-27 |
Name of individual signing |
LONNIE CASEY |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2015-07-27 |
Name of individual signing |
LONNIE CASEY |
Valid signature |
Filed with authorized/valid electronic signature |
|
|