SOUTHERN IMPERIAL LLC MEDICAL PLAN
|
2018
|
821889187
|
2019-07-30
|
SOUTHERN IMPERIAL LLC
|
403
|
|
Three-digit plan number (PN) |
510
|
Effective date of plan |
1996-05-01
|
Business code |
332610
|
Sponsor’s telephone number |
8158777041
|
Plan
sponsor’s DBA name |
SIFFRON
|
Plan sponsor’s mailing address |
1400 EDDY AVE, ROCKFORD, IL, 611033171
|
Plan sponsor’s
address |
1400 EDDY AVE, ROCKFORD, IL, 611033171
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2019-07-30 |
Name of individual signing |
SHANNON WEST |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
SOUTHERN IMPERIAL LLC MEDICAL PLAN
|
2018
|
821889187
|
2019-07-30
|
SOUTHERN IMPERIAL LLC
|
403
|
|
File |
View Page
|
Three-digit plan number (PN) |
510
|
Effective date of plan |
1996-05-01
|
Business code |
332610
|
Sponsor’s telephone number |
8158777041
|
Plan
sponsor’s DBA name |
SIFFRON
|
Plan sponsor’s mailing address |
1400 EDDY AVE, ROCKFORD, IL, 611033171
|
Plan sponsor’s
address |
1400 EDDY AVE, ROCKFORD, IL, 611033171
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2019-07-30 |
Name of individual signing |
SHANNON WEST |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
SI LLC OTHER BENEFITS GUARDIAN
|
2018
|
821889187
|
2019-07-30
|
SOUTHERN IMPERIAL LLC
|
239
|
|
File |
View Page
|
Three-digit plan number (PN) |
511
|
Effective date of plan |
1996-05-01
|
Business code |
332610
|
Sponsor’s telephone number |
8158777041
|
Plan
sponsor’s DBA name |
SIFFRON
|
Plan sponsor’s mailing address |
1400 EDDY AVE, ROCKFORD, IL, 611033171
|
Plan sponsor’s
address |
1400 EDDY AVE, ROCKFORD, IL, 611033171
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2019-07-30 |
Name of individual signing |
SHANNON WEST |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
SI LLC OTHER BENEFITS GUARDIAN
|
2017
|
821889187
|
2018-07-31
|
SOUTHERN IMPERIAL LLC
|
247
|
|
File |
View Page
|
Three-digit plan number (PN) |
511
|
Effective date of plan |
1996-05-01
|
Business code |
332610
|
Sponsor’s telephone number |
8158777041
|
Plan
sponsor’s DBA name |
SIFFRON
|
Plan sponsor’s mailing address |
1400 EDDY AVE, ROCKFORD, IL, 611033171
|
Plan sponsor’s
address |
1400 EDDY AVE, ROCKFORD, IL, 611033171
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2018-07-31 |
Name of individual signing |
NIKKI SCHIRO |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-07-31 |
Name of individual signing |
NIKKI SCHIRO |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
SOUTHERN IMPERIAL LLC MEDICAL PLAN
|
2017
|
821889187
|
2018-07-31
|
SOUTHERN IMPERIAL LLC
|
197
|
|
File |
View Page
|
Three-digit plan number (PN) |
510
|
Effective date of plan |
1996-05-01
|
Business code |
332610
|
Sponsor’s telephone number |
8158777041
|
Plan
sponsor’s DBA name |
SIFFRON
|
Plan sponsor’s mailing address |
1400 EDDY AVE, ROCKFORD, IL, 611033171
|
Plan sponsor’s
address |
1400 EDDY AVE, ROCKFORD, IL, 611033171
|
Number of participants as of the end of the plan year
Active participants |
403 |
Retired or separated participants receiving
benefits |
9 |
Signature of
Role |
Plan administrator |
Date |
2018-07-31 |
Name of individual signing |
NIKKI SCHIRO |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-07-31 |
Name of individual signing |
NIKKI SCHIRO |
Valid signature |
Filed with authorized/valid electronic signature |
|
|