BLACKJACK GARDENS, INC. 401(K) PLAN
|
2023
|
721392923
|
2024-08-13
|
BLACKJACK GARDENS, INC.
|
13
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|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2002-09-01
|
Business code |
442110
|
Sponsor’s telephone number |
2055332800
|
Plan sponsor’s
address |
5549 DERBY DRIVE, BIRMINGHAM, AL, 35210
|
Signature of
Role |
Plan administrator |
Date |
2024-08-13 |
Name of individual signing |
SAMANTHA KERZIC |
|
|
BLACKJACK GARDENS, INC. 401(K) PLAN
|
2022
|
721392923
|
2023-06-28
|
BLACKJACK GARDENS, INC.
|
13
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2002-09-01
|
Business code |
442110
|
Sponsor’s telephone number |
2055332800
|
Plan sponsor’s
address |
5549 DERBY DRIVE, BIRMINGHAM, AL, 35210
|
Signature of
Role |
Plan administrator |
Date |
2023-06-22 |
Name of individual signing |
SAMANTHA KERZIC |
|
|
BLACKJACK GARDENS, INC. 401(K) PLAN
|
2021
|
721392923
|
2022-08-09
|
BLACKJACK GARDENS, INC.
|
14
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2002-09-01
|
Business code |
442110
|
Sponsor’s telephone number |
2055332800
|
Plan sponsor’s
address |
PO BOX 10383, 3021 7TH AVENUE SOUTH, BIRMINGHAM, AL, 35210
|
Signature of
Role |
Plan administrator |
Date |
2022-08-09 |
Name of individual signing |
SAMANTHA KERZIC |
|
Role |
Employer/plan sponsor |
Date |
2022-08-09 |
Name of individual signing |
SAMANTHA KERZIC |
|
|
BLACKJACK GARDENS, INC. 401(K) PLAN
|
2020
|
721392923
|
2021-09-08
|
BLACKJACK GARDENS, INC.
|
14
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2002-09-01
|
Business code |
442110
|
Sponsor’s telephone number |
2055332800
|
Plan sponsor’s
address |
PO BOX 10383, 3021 7TH AVENUE SOUTH, BIRMINGHAM, AL, 35210
|
Signature of
Role |
Plan administrator |
Date |
2021-09-08 |
Name of individual signing |
SAMANTHA H M KERZIC |
|
Role |
Employer/plan sponsor |
Date |
2021-09-08 |
Name of individual signing |
SAMANTHA H M KERZIC |
|
|
BLACKJACK GARDENS, INC 401(K) PLAN
|
2019
|
721392923
|
2020-06-16
|
BLACKJACK GARDENS, INC.
|
15
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2002-09-01
|
Business code |
442110
|
Sponsor’s telephone number |
2057141126
|
Plan sponsor’s
address |
PO BOX 10383, 3021 7TH AVENUE SOUTH, BIRMINGHAM, AL, 35210
|
Signature of
Role |
Plan administrator |
Date |
2020-06-16 |
Name of individual signing |
SAMANTHA HM KERZIC |
|
|
BLACKJACK GARDENS, INC 401(K) PLAN
|
2018
|
721392923
|
2019-06-07
|
BLACKJACK GARDENS, INC.
|
15
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2002-09-01
|
Business code |
442210
|
Sponsor’s telephone number |
2057141126
|
Plan sponsor’s
address |
PO BOX 10383, 3021 7TH AVENUE SOUTH, BIRMINGHAM, AL, 35210
|
Signature of
Role |
Plan administrator |
Date |
2019-06-07 |
Name of individual signing |
SAMANTHA KERZIC |
|
|
BLACKJACK GARDENS, INC 401(K) PLAN
|
2017
|
721392923
|
2018-05-10
|
BLACKJACK GARDENS, INC.
|
15
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2002-09-01
|
Business code |
442110
|
Sponsor’s telephone number |
2057141126
|
Plan sponsor’s
address |
PO BOX 10383, 3021 7TH AVENUE SOUTH, BIRMINGHAM, AL, 35210
|
Signature of
Role |
Plan administrator |
Date |
2018-05-10 |
Name of individual signing |
SAMANTHA KERZIC |
|
Role |
Employer/plan sponsor |
Date |
2018-05-10 |
Name of individual signing |
SAMANTHA KERZIC |
|
|
BLACKJACK GARDENS, INC 401(K) PLAN
|
2016
|
721392923
|
2017-08-31
|
BLACKJACK GARDENS, INC.
|
15
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2002-09-01
|
Business code |
111400
|
Plan sponsor’s
address |
PO BOX 10383, 3021 7TH AVENUE SOUTH, BIRMINGHAM, AL, 35210
|
Signature of
Role |
Plan administrator |
Date |
2017-08-31 |
Name of individual signing |
SAMANTHA KERZIC |
|
|
BLACKJACK GARDENS, INC 401(K) PLAN
|
2015
|
721392923
|
2016-06-27
|
BLACKJACK GARDENS, INC
|
14
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2002-09-01
|
Business code |
111400
|
Sponsor’s telephone number |
2055332800
|
Plan sponsor’s
address |
5549 DERBY DR, BIRMINGHAM, AL, 35210
|
Signature of
Role |
Plan administrator |
Date |
2016-06-27 |
Name of individual signing |
SAMANTHA KERZIC |
|
|
BLACKJACK GARDENS, INC 401(K) PLAN
|
2014
|
721392923
|
2015-07-09
|
BLACKJACK GARDENS, INC
|
14
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2002-09-01
|
Business code |
111400
|
Sponsor’s telephone number |
2057141134
|
Plan sponsor’s
address |
3021 7TH AVENUE SOUTH, PO BOX 10383, BIRMINGHAM, AL, 35210
|
Signature of
Role |
Plan administrator |
Date |
2015-07-09 |
Name of individual signing |
SAMANTHA KERZIC |
|
|