|
MAVIS TIRE NY, INC. HEALTH PLAN
|
2009
|
263628364
|
2011-09-15
|
MAVIS TIRE NY, INC.
|
358
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2008-12-01
|
| Business code |
441300
|
| Sponsor’s telephone number |
9146666750
|
| Plan sponsor’s mailing address |
358 SAW MILL RIVER ROAD, MILLWOOD, NY, 10546
|
| Plan sponsor’s
address |
358 SAW MILL RIVER ROAD, MILLWOOD, NY, 10546
|
Plan administrator’s name and address
| Administrator’s EIN |
263628364 |
| Plan administrator’s name |
MAVIS TIRE NY, INC. |
| Plan administrator’s
address |
358 SAW MILL RIVER ROAD, MILLWOOD, NY, 10546 |
| Administrator’s telephone number |
9146666750 |
Number of participants as of the end of the plan year
Signature of
| Role |
Plan administrator |
| Date |
2011-09-15 |
| Name of individual signing |
PAIGE KOUDIJS |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2011-09-15 |
| Name of individual signing |
PAIGE KOUDIJS |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
MAVIS TIRE NY, INC. HEALTH PLAN
|
2009
|
263628364
|
2010-12-29
|
MAVIS TIRE NY, INC.
|
0
|
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2009-11-30
|
| Business code |
441300
|
| Sponsor’s telephone number |
9146666750
|
| Plan sponsor’s mailing address |
358 SAW MILL RIVER ROAD, MILLWOOD, NY, 10546
|
| Plan sponsor’s
address |
358 SAW MILL RIVER ROAD, MILLWOOD, NY, 10546
|
Plan administrator’s name and address
| Administrator’s EIN |
263628364 |
| Plan administrator’s name |
MAVIS TIRE NY, INC. |
| Plan administrator’s
address |
358 SAW MILL RIVER ROAD, MILLWOOD, NY, 10546 |
| Administrator’s telephone number |
9146666750 |
Number of participants as of the end of the plan year
Signature of
| Role |
Plan administrator |
| Date |
2010-12-21 |
| Name of individual signing |
PAIGE KOUDIJS |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2010-12-21 |
| Name of individual signing |
PAIGE KOUDIJS |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
MAVIS TIRE NY, INC. HEALTH PLAN
|
2009
|
263628364
|
2010-12-30
|
MAVIS TIRE NY, INC.
|
0
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2008-12-01
|
| Business code |
441300
|
| Sponsor’s telephone number |
9146666750
|
| Plan sponsor’s mailing address |
358 SAW MILL RIVER ROAD, MILLWOOD, NY, 10546
|
| Plan sponsor’s
address |
358 SAW MILL RIVER ROAD, MILLWOOD, NY, 10546
|
Plan administrator’s name and address
| Administrator’s EIN |
263628364 |
| Plan administrator’s name |
MAVIS TIRE NY, INC. |
| Plan administrator’s
address |
358 SAW MILL RIVER ROAD, MILLWOOD, NY, 10546 |
| Administrator’s telephone number |
9146666750 |
Number of participants as of the end of the plan year
Signature of
| Role |
Plan administrator |
| Date |
2010-12-21 |
| Name of individual signing |
PAIGE KOUDIJS |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2010-12-21 |
| Name of individual signing |
PAIGE KOUDIJS |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
