WELFARE HEALTH PLAN - SUPREME BEVERAGE
|
2020
|
630459214
|
2022-04-05
|
SUPREME BEVERAGE COMPANY, INC
|
139
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2017-03-01
|
Business code |
424800
|
Sponsor’s telephone number |
2565341482
|
Plan
sponsor’s DBA name |
SUPREME BEVERAGE COMPANY
|
Plan sponsor’s mailing address |
5860 ENDEAVOR WAY, TANNER, AL, 356713005
|
Plan sponsor’s
address |
5860 ENDEAVOR WAY, TANNER, AL, 356713005
|
Plan administrator’s name and address
Administrator’s EIN |
472506773 |
Plan administrator’s name |
KENNION & CO, LLC |
Plan administrator’s
address |
800 CORPORATE PKWY STE 100, BIRMINGHAM, AL, 352425470 |
Administrator’s telephone number |
8669665457 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2021-10-14 |
Name of individual signing |
WILSON SHEPHERD |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
SUPREME BEVERAGE LIFE INSURANCE PLAN
|
2020
|
630459214
|
2021-04-19
|
SUPREME BEVERAGE COMPANY, INC.
|
194
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1989-08-10
|
Business code |
424800
|
Sponsor’s telephone number |
2565341482
|
Plan sponsor’s mailing address |
PO BOX 131028, 3900 MONTCLAIR RD FL 1, BIRMINGHAM, AL, 352132429
|
Plan sponsor’s
address |
5860 ENDEAVOR WAY, TANNER, AL, 35671
|
Number of participants as of the end of the plan year
Active participants |
0 |
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 |
Signature of
Role |
Plan administrator |
Date |
2021-04-19 |
Name of individual signing |
SUZIE BULLOCK |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2021-04-19 |
Name of individual signing |
SUZIE BULLOCK |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
WELFARE HEALTH PLAN FOR SUPREME BEVERAGE
|
2019
|
630459214
|
2020-10-14
|
SUPREME BEVERAGE COMPANY, INC
|
130
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2017-03-01
|
Business code |
424800
|
Sponsor’s telephone number |
2565341482
|
Plan
sponsor’s DBA name |
SUPREME BEVERAGE COMPANY
|
Plan sponsor’s mailing address |
5860 ENDEAVOR WAY, TANNER, AL, 356713005
|
Plan sponsor’s
address |
5860 ENDEAVOR WAY, TANNER, AL, 356713005
|
Plan administrator’s name and address
Administrator’s EIN |
472506773 |
Plan administrator’s name |
KENNION & CO, LLC |
Plan administrator’s
address |
800 CORPORATE PKWY STE 100, BIRMINGHAM, AL, 352425470 |
Administrator’s telephone number |
8669665457 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2020-10-13 |
Name of individual signing |
WILSON SHEPHERD |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
SUPREME BEVERAGE LIFE INSURANCE PLAN
|
2019
|
630459214
|
2020-07-30
|
SUPREME BEVERAGE COMPANY, INC.
|
193
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1989-08-10
|
Business code |
424800
|
Sponsor’s telephone number |
2565341482
|
Plan sponsor’s mailing address |
5860 ENDEAVOR WAY, TANNER, AL, 356713005
|
Plan sponsor’s
address |
5860 ENDEAVOR WAY, TANNER, AL, 356713005
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2020-07-30 |
Name of individual signing |
SUZIE BULLOCK |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2020-07-30 |
Name of individual signing |
SUZIE BULLOCK |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
WELFARE HEALTH PLAN FOR SUPREME BEVERAGE
|
2018
|
630459214
|
2019-10-14
|
SUPREME BEVERAGE COMPANY, INC
|
134
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2017-03-01
|
Business code |
424800
|
Sponsor’s telephone number |
2052518010
|
Plan
sponsor’s DBA name |
SUPREME BEVERAGE COMPANY
|
Plan sponsor’s mailing address |
3217 AIRPORT HWY, BIRMINGHAM, AL, 352221259
|
Plan sponsor’s
address |
5865 OLD LEEDS RD, STE A, BIRMGINAHAM, AL, 35210
|
Plan administrator’s name and address
Administrator’s EIN |
472506773 |
Plan administrator’s name |
KENNION & CO, LLC |
Plan administrator’s
address |
800 CORPORATE PKWY STE 100, BIRMINGHAM, AL, 352425470 |
Administrator’s telephone number |
8669665457 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2019-10-13 |
Name of individual signing |
WILSON SHEPHERD |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
WELFARE HEALTH PLAN FOR SUPREME BEVERAGE
|
2018
|
630459214
|
2019-10-03
|
SUPREME BEVERAGE COMPANY, INC
|
134
|
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2017-03-01
|
Business code |
424800
|
Sponsor’s telephone number |
2052518010
|
Plan
sponsor’s DBA name |
SUPREME BEVERAGE COMPANY
|
Plan sponsor’s mailing address |
3217 AIRPORT HWY, BIRMINGHAM, AL, 352221259
|
Plan sponsor’s
address |
5865 OLD LEEDS RD, STE A, BIRMGINAHAM, AL, 35210
|
Plan administrator’s name and address
Administrator’s EIN |
472506773 |
Plan administrator’s name |
KENNION & CO, LLC |
Plan administrator’s
address |
800 CORPORATE PKWY STE 100, BIRMINGHAM, AL, 352425470 |
Administrator’s telephone number |
8669665457 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2019-10-02 |
Name of individual signing |
WILSON SHEPHERD |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
SUPREME BEVERAGE LIFE INSURANCE PLAN
|
2018
|
630459214
|
2019-07-04
|
SUPREME BEVERAGE COMPANY, INC.
|
190
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1989-08-10
|
Business code |
424800
|
Sponsor’s telephone number |
2565341482
|
Plan sponsor’s mailing address |
5860 ENDEAVOR WAY, TANNER, AL, 356713012
|
Plan sponsor’s
address |
5860 ENDEAVOR WAY, TANNER, AL, 356713012
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2019-07-04 |
Name of individual signing |
SUZIE BULLOCK |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
WELFARE HEALTH PLAN FOR SUPREME BEVERAGE
|
2017
|
630459214
|
2018-10-15
|
SUPREME BEVERAGE COMPANY, INC
|
150
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2017-03-01
|
Business code |
424800
|
Sponsor’s telephone number |
2052518010
|
Plan
sponsor’s DBA name |
SUPREME BEVERAGE COMPANY
|
Plan sponsor’s mailing address |
3217 AIRPORT HWY, BIRMINGHAM, AL, 352221259
|
Plan sponsor’s
address |
5865 OLD LEEDS RD, STE A, BIRMGINAHAM, AL, 35210
|
Plan administrator’s name and address
Administrator’s EIN |
472506773 |
Plan administrator’s name |
KENNION & CO, LLC |
Plan administrator’s
address |
800 CORPORATE PKWY STE 100, BIRMINGHAM, AL, 352425470 |
Administrator’s telephone number |
8669665457 |
Number of participants as of the end of the plan year
Active participants |
133 |
Retired or separated participants receiving
benefits |
1 |
Signature of
Role |
Plan administrator |
Date |
2018-10-15 |
Name of individual signing |
WILSON SHEPHERD |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
SUPREME BEVERAGE LIFE INSURANCE PLAN
|
2017
|
630459214
|
2018-11-01
|
SUPREME BEVERAGE COMPANY, INC.
|
352
|
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1989-08-10
|
Business code |
424800
|
Sponsor’s telephone number |
2565341482
|
Plan sponsor’s mailing address |
5860 ENDEAVOR WAY, TANNER, AL, 356713012
|
Plan sponsor’s
address |
5860 ENDEAVOR WAY, TANNER, AL, 356713012
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2018-10-31 |
Name of individual signing |
SUZIE BULLOCK |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-10-31 |
Name of individual signing |
SUZIE BULLOCK |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
SUPREME BEVERAGE HEALTH INSURANCE PLAN
|
2016
|
630459214
|
2017-11-01
|
SUPREME BEVERAGE COMPANY, INC.
|
213
|
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
1989-08-01
|
Business code |
424800
|
Sponsor’s telephone number |
2565341482
|
Plan
sponsor’s DBA name |
SUPREME BEVERAGE COMPANY
|
Plan sponsor’s mailing address |
PO BOX 2027, HUNTSVILLE, AL, 358042027
|
Plan sponsor’s
address |
2100A JACKSON AVE, HUNTSVILLE, AL, 35805
|
Plan administrator’s name and address
Administrator’s EIN |
630459214 |
Plan administrator’s name |
SUPREME BEVERAGE COMPANY, INC. |
Plan administrator’s
address |
2100A JACKSON AVE NW, HUNTSVILLE, AL, 358052950 |
Administrator’s telephone number |
2565341482 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2017-10-31 |
Name of individual signing |
SUZIE BULLOCK |
Valid signature |
Filed with authorized/valid electronic signature |
|
|