DESHAZO LLC LINCOLN DENTAL
|
2021
|
631169999
|
2022-07-11
|
DESHAZO LLC
|
271
|
|
File |
View Page
|
Three-digit plan number (PN) |
511
|
Effective date of plan |
2020-01-01
|
Business code |
333200
|
Sponsor’s telephone number |
2057454138
|
Plan sponsor’s mailing address |
200 KILSBY CIR, BESSEMER, AL, 350224062
|
Plan sponsor’s
address |
200 KILSBY CIR, BESSEMER, AL, 350224062
|
Number of participants as of the end of the plan year
Active participants |
285 |
Retired or separated participants receiving
benefits |
2 |
Signature of
Role |
Plan administrator |
Date |
2022-07-11 |
Name of individual signing |
CONSUELA ROWE |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2022-07-11 |
Name of individual signing |
CONSUELA ROWE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
DESAHZO LLC LINCOLN LIFE AND AD&D
|
2021
|
631169999
|
2022-07-11
|
DESHAZO LLC
|
332
|
|
File |
View Page
|
Three-digit plan number (PN) |
512
|
Effective date of plan |
2020-01-01
|
Business code |
333200
|
Sponsor’s telephone number |
2057454138
|
Plan
sponsor’s DBA name |
DESHAZO LLC
|
Plan sponsor’s mailing address |
200 KILSBY CIR, BESSEMER, AL, 350224062
|
Plan sponsor’s
address |
200 KILSBY CIR, BESSEMER, AL, 350224062
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2022-07-11 |
Name of individual signing |
CONSUELA ROWE |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2022-07-11 |
Name of individual signing |
CONSUELA ROWE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
DESHAZO LLC LINCOLN LTD
|
2021
|
631169999
|
2022-07-11
|
DESHAZO LLC
|
236
|
|
File |
View Page
|
Three-digit plan number (PN) |
513
|
Effective date of plan |
2020-01-01
|
Business code |
333200
|
Sponsor’s telephone number |
2057454138
|
Plan sponsor’s mailing address |
200 KILSBY CIR, BESSEMER, AL, 350224062
|
Plan sponsor’s
address |
200 KILSBY CIR, BESSEMER, AL, 350224062
|
Number of participants as of the end of the plan year
Active participants |
234 |
Retired or separated participants receiving
benefits |
4 |
Signature of
Role |
Plan administrator |
Date |
2022-07-11 |
Name of individual signing |
CONSUELA ROWE |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2022-07-11 |
Name of individual signing |
CONSUELA ROWE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
DESHAZO LLC LINCOLN VOL LIFE
|
2021
|
631169999
|
2022-07-11
|
DESHAZO LLC
|
209
|
|
File |
View Page
|
Three-digit plan number (PN) |
514
|
Effective date of plan |
2020-01-01
|
Business code |
333200
|
Sponsor’s telephone number |
2057454138
|
Plan sponsor’s mailing address |
200 KILSBY CIR, BESSEMER, AL, 350224062
|
Plan sponsor’s
address |
200 KILSBY CIR, BESSEMER, AL, 350224062
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2022-07-11 |
Name of individual signing |
CONSUELA ROWE |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2022-07-11 |
Name of individual signing |
CONSUELA ROWE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
DESHAZO LLC VSP VISION PLAN
|
2021
|
631169999
|
2022-07-11
|
DESHAZO LLC
|
258
|
|
File |
View Page
|
Three-digit plan number (PN) |
516
|
Effective date of plan |
2020-01-01
|
Business code |
333200
|
Sponsor’s telephone number |
2057454138
|
Plan sponsor’s mailing address |
200 KILSBY CIR, BESSEMER, AL, 350224062
|
Plan sponsor’s
address |
200 KILSBY CIR, BESSEMER, AL, 350224062
|
Number of participants as of the end of the plan year
Active participants |
269 |
Retired or separated participants receiving
benefits |
2 |
Signature of
Role |
Plan administrator |
Date |
2022-07-11 |
Name of individual signing |
CONSUELA ROWE |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2022-07-11 |
Name of individual signing |
CONSUELA ROWE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
DESHAZO LLC LINCOLN STD
|
2021
|
631169999
|
2022-07-11
|
DESHAZO LLC
|
245
|
|
File |
View Page
|
Three-digit plan number (PN) |
515
|
Effective date of plan |
2020-01-01
|
Business code |
333200
|
Sponsor’s telephone number |
2057454138
|
Plan sponsor’s mailing address |
200 KILSBY CIR, BESSEMER, AL, 350224062
|
Plan sponsor’s
address |
200 KILSBY CIR, BESSEMER, AL, 350224062
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2022-07-11 |
Name of individual signing |
CONSUELA ROWE |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2022-07-11 |
Name of individual signing |
CONSUELA ROWE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
DESHAZO LLC LINCOLN CI
|
2021
|
631169999
|
2022-07-22
|
DESHAZO LLC
|
153
|
|
File |
View Page
|
Three-digit plan number (PN) |
510
|
Effective date of plan |
2020-01-01
|
Business code |
333200
|
Sponsor’s telephone number |
2057454138
|
Plan sponsor’s mailing address |
200 KILSBY CIR, BESSEMER, AL, 350224062
|
Plan sponsor’s
address |
200 KILSBY CIR, BESSEMER, AL, 350224062
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2022-07-22 |
Name of individual signing |
CONSUELA ROWE |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2022-07-22 |
Name of individual signing |
CONSUELA ROWE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
DESHAZO LLC LINCOLN ACCIDENT
|
2021
|
631169999
|
2022-07-22
|
DESHAZO LLC
|
223
|
|
File |
View Page
|
Three-digit plan number (PN) |
509
|
Effective date of plan |
2020-01-01
|
Business code |
333200
|
Sponsor’s telephone number |
2057454138
|
Plan sponsor’s mailing address |
200 KILSBY CIR, BESSEMER, AL, 350224062
|
Plan sponsor’s
address |
200 KILSBY CIR, BESSEMER, AL, 350224062
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2022-07-11 |
Name of individual signing |
CONSUELA ROWE |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2022-07-11 |
Name of individual signing |
CONSUELA ROWE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
DESHAZO BCBS HEALTH PLAN
|
2021
|
631169999
|
2022-07-22
|
DESHAZO LLC
|
294
|
|
File |
View Page
|
Three-digit plan number (PN) |
517
|
Effective date of plan |
2021-01-01
|
Business code |
333200
|
Sponsor’s telephone number |
2057454138
|
Plan
sponsor’s DBA name |
DESHAZO LLC
|
Plan sponsor’s mailing address |
200 KILSBY CIR, BESSEMER, AL, 350224062
|
Plan sponsor’s
address |
200 KILSBY CIR, BESSEMER, AL, 350224062
|
Number of participants as of the end of the plan year
Active participants |
288 |
Retired or separated participants receiving
benefits |
3 |
Signature of
Role |
Plan administrator |
Date |
2022-07-22 |
Name of individual signing |
CONSUELA ROWE |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2022-07-22 |
Name of individual signing |
CONSUELA ROWE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
DESHAZO LLC VSP VISION PLAN
|
2020
|
631169999
|
2021-10-13
|
DESHAZO LLC
|
317
|
|
File |
View Page
|
Three-digit plan number (PN) |
516
|
Effective date of plan |
2020-01-01
|
Business code |
333200
|
Sponsor’s telephone number |
2057454138
|
Plan sponsor’s mailing address |
200 KILSBY CIR, BESSEMER, AL, 350224062
|
Plan sponsor’s
address |
200 KILSBY CIR, BESSEMER, AL, 350224062
|
Number of participants as of the end of the plan year
Active participants |
256 |
Retired or separated participants receiving
benefits |
2 |
Signature of
Role |
Plan administrator |
Date |
2021-10-13 |
Name of individual signing |
CONSUELA ROWE |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2021-10-13 |
Name of individual signing |
CONSUELA ROWE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|