DELTACOM, INC. SECTION 125 CAFETERIA/BENEFIT PLAN
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2010
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630832070
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2011-08-10
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DELTACOM, INC
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368
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File |
View Page
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Three-digit plan number (PN) |
505
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Effective date of plan |
1996-03-01
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Business code |
517000
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Sponsor’s telephone number |
2563825960
|
Plan sponsor’s mailing address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806
|
Plan sponsor’s
address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806
|
Plan administrator’s name and address
Administrator’s EIN |
630832070 |
Plan administrator’s name |
KATHY SHORT |
Plan administrator’s
address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806 |
Administrator’s telephone number |
2563825960 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2011-08-10 |
Name of individual signing |
KATHY SHORT |
Valid signature |
Filed with authorized/valid electronic signature |
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GROUP HEALTH CARE PLAN
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2010
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630832070
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2011-08-10
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DELTACOM, INC
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1203
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File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1998-01-01
|
Business code |
517000
|
Sponsor’s telephone number |
2563825960
|
Plan sponsor’s mailing address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806
|
Plan sponsor’s
address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806
|
Plan administrator’s name and address
Administrator’s EIN |
630832070 |
Plan administrator’s name |
KATHY SHORT |
Plan administrator’s
address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806 |
Administrator’s telephone number |
2563825960 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2011-08-10 |
Name of individual signing |
KATHY SHORT |
Valid signature |
Filed with authorized/valid electronic signature |
|
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GROUP VISION PLAN
|
2010
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630832070
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2011-08-10
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DELTACOM, INC
|
864
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|
File |
View Page
|
Three-digit plan number (PN) |
511
|
Effective date of plan |
2005-01-01
|
Business code |
517000
|
Sponsor’s telephone number |
2563825960
|
Plan sponsor’s mailing address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806
|
Plan sponsor’s
address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806
|
Plan administrator’s name and address
Administrator’s EIN |
630832070 |
Plan administrator’s name |
KATHY SHORT |
Plan administrator’s
address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806 |
Administrator’s telephone number |
2563825960 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2011-08-10 |
Name of individual signing |
KATHY SHORT |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
SUPPLEMENTAL CANCER CARE, INTENSIVE CARE AND PERSO NAL ACCIDENT PLAN
|
2010
|
630832070
|
2011-08-10
|
DELTACOM, INC.
|
382
|
|
File |
View Page
|
Three-digit plan number (PN) |
508
|
Effective date of plan |
1998-01-01
|
Business code |
517000
|
Sponsor’s telephone number |
2563825960
|
Plan sponsor’s mailing address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806
|
Plan sponsor’s
address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806
|
Plan administrator’s name and address
Administrator’s EIN |
630832070 |
Plan administrator’s name |
KATHY SHORT |
Plan administrator’s
address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806 |
Administrator’s telephone number |
2563825960 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2011-08-10 |
Name of individual signing |
KATHY SHORT |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
SUPPLEMENTAL LIFE INSURANCE PLAN
|
2010
|
630832070
|
2011-08-10
|
DELTACOM, INC
|
540
|
|
File |
View Page
|
Three-digit plan number (PN) |
506
|
Effective date of plan |
1998-01-01
|
Business code |
517000
|
Sponsor’s telephone number |
2563825960
|
Plan sponsor’s mailing address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806
|
Plan sponsor’s
address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806
|
Plan administrator’s name and address
Administrator’s EIN |
630832070 |
Plan administrator’s name |
KATHY SHORT |
Plan administrator’s
address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806 |
Administrator’s telephone number |
2563825960 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2011-08-10 |
Name of individual signing |
KATHY SHORT |
Valid signature |
Filed with authorized/valid electronic signature |
|
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GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE PLAN
|
2010
|
630832070
|
2011-08-10
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DELTACOM, INC
|
1324
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1997-04-01
|
Business code |
517000
|
Sponsor’s telephone number |
2563825960
|
Plan sponsor’s mailing address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806
|
Plan sponsor’s
address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806
|
Plan administrator’s name and address
Administrator’s EIN |
630832070 |
Plan administrator’s name |
KATHY SHORT |
Plan administrator’s
address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806 |
Administrator’s telephone number |
2563825960 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2011-08-10 |
Name of individual signing |
KATHY SHORT |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LONG TERM DISABILITY PLAN
|
2010
|
630832070
|
2011-08-10
|
DELTACOM, INC
|
1324
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
1997-04-01
|
Business code |
517000
|
Sponsor’s telephone number |
2563825960
|
Plan sponsor’s mailing address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806
|
Plan sponsor’s
address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806
|
Plan administrator’s name and address
Administrator’s EIN |
630832070 |
Plan administrator’s name |
KATHY SHORT |
Plan administrator’s
address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806 |
Administrator’s telephone number |
2563825960 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2011-08-10 |
Name of individual signing |
KATHY SHORT |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
SHORT TERM DISABILITY PLAN
|
2010
|
630832070
|
2011-08-10
|
DELTACOM, INC
|
570
|
|
File |
View Page
|
Three-digit plan number (PN) |
510
|
Effective date of plan |
2001-01-01
|
Business code |
517000
|
Sponsor’s telephone number |
2563825960
|
Plan sponsor’s mailing address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806
|
Plan sponsor’s
address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806
|
Plan administrator’s name and address
Administrator’s EIN |
630832070 |
Plan administrator’s name |
KATHY SHORT |
Plan administrator’s
address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806 |
Administrator’s telephone number |
2563825960 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2011-08-10 |
Name of individual signing |
KATHY SHORT |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
TRAVEL ACCIDENT INSURANCE PLAN
|
2010
|
630832070
|
2011-08-10
|
DELTACOM, INC
|
1324
|
|
File |
View Page
|
Three-digit plan number (PN) |
504
|
Effective date of plan |
1998-01-01
|
Business code |
517000
|
Sponsor’s telephone number |
2563825960
|
Plan sponsor’s mailing address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806
|
Plan sponsor’s
address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806
|
Plan administrator’s name and address
Administrator’s EIN |
630832070 |
Plan administrator’s name |
KATHY SHORT |
Plan administrator’s
address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806 |
Administrator’s telephone number |
2563825960 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2011-08-10 |
Name of individual signing |
KATHY SHORT |
Valid signature |
Filed with authorized/valid electronic signature |
|
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SECTION 127 - TUITION REIMBURSEMENT PLAN
|
2010
|
630832070
|
2011-08-10
|
DELTACOM, INC
|
1324
|
|
File |
View Page
|
Three-digit plan number (PN) |
507
|
Effective date of plan |
1998-01-01
|
Business code |
517000
|
Sponsor’s telephone number |
2563825960
|
Plan sponsor’s mailing address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806
|
Plan sponsor’s
address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806
|
Plan administrator’s name and address
Administrator’s EIN |
630832070 |
Plan administrator’s name |
KATHY SHORT |
Plan administrator’s
address |
7037 OLD MADISON PIKE, HUNTSVILLE, AL, 35806 |
Administrator’s telephone number |
2563825960 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2011-08-10 |
Name of individual signing |
KATHY SHORT |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2011-08-10 |
Name of individual signing |
KATHY SHORT |
Valid signature |
Filed with authorized/valid electronic signature |
|
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