CAPITAL CITY BEVERAGES WELFARE PLAN
|
2022
|
640120572
|
2023-04-24
|
CAPITAL CITY BEVERAGES, INC.
|
111
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2007-06-01
|
Business code |
424800
|
Sponsor’s telephone number |
6019562224
|
Plan
sponsor’s DBA name |
CAPITAL CITY BEVERAGES, INC.
|
Plan sponsor’s mailing address |
920 W COUNTY LINE RD, JACKSON, MS, 392139315
|
Plan sponsor’s
address |
920 W COUNTY LINE RD, JACKSON, MS, 392139315
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2023-04-24 |
Name of individual signing |
ROBERT VOLLENWEIDER |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2023-04-24 |
Name of individual signing |
ROBERT VOLLENWEIDER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CAPITAL CITY BEVERAGES WELFARE PLAN
|
2021
|
640120572
|
2022-04-01
|
CAPITAL CITY BEVERAGES, INC.
|
105
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2007-06-01
|
Business code |
424800
|
Sponsor’s telephone number |
6019562224
|
Plan
sponsor’s DBA name |
CAPITAL CITY BEVERAGES, INC.
|
Plan sponsor’s mailing address |
920 W COUNTY LINE RD, JACKSON, MS, 392139315
|
Plan sponsor’s
address |
920 W COUNTY LINE RD, JACKSON, MS, 392139315
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2022-04-01 |
Name of individual signing |
ROBERT VOLLENWEIDER |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2022-04-01 |
Name of individual signing |
ROBERT VOLLENWEIDER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CAPITAL CITY BEVERAGES WELFARE PLAN
|
2020
|
640120572
|
2021-10-12
|
CAPITAL CITY BEVERAGES, INC.
|
108
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2007-06-01
|
Business code |
424800
|
Sponsor’s telephone number |
6019562224
|
Plan
sponsor’s DBA name |
CAPITAL CITY BEVERAGES, INC.
|
Plan sponsor’s mailing address |
920 W COUNTY LINE RD, JACKSON, MS, 392139315
|
Plan sponsor’s
address |
920 W COUNTY LINE RD, JACKSON, MS, 392139315
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2021-10-12 |
Name of individual signing |
ROBERT VOLLENWEIDER |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2021-10-12 |
Name of individual signing |
ROBERT VOLLENWEIDER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CAPITAL CITY BEVERAGES WELFARE PLAN
|
2019
|
640120572
|
2020-09-28
|
CAPITAL CITY BEVERAGES, INC.
|
103
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2007-06-01
|
Business code |
424800
|
Sponsor’s telephone number |
6019562224
|
Plan sponsor’s mailing address |
920 W COUNTY LINE RD, JACKSON, MS, 392139315
|
Plan sponsor’s
address |
920 W COUNTY LINE RD, JACKSON, MS, 392139315
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2020-09-28 |
Name of individual signing |
ROBERT VOLLENWEIDER |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2020-09-28 |
Name of individual signing |
ROBERT VOLLENWEIDER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CAPITAL CITY BEVERAGES WELFARE PLAN
|
2018
|
640120572
|
2019-08-23
|
CAPITAL CITY BEVERAGES, INC
|
102
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2007-06-01
|
Business code |
424800
|
Sponsor’s telephone number |
6019562224
|
Plan sponsor’s mailing address |
920 W COUNTY LINE RD, JACKSON, MS, 392139315
|
Plan sponsor’s
address |
920 W COUNTY LINE RD, JACKSON, MS, 392139315
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2019-08-23 |
Name of individual signing |
ROBERT VOLLENWEIDER |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2019-08-23 |
Name of individual signing |
ROBERT VOLLENWEIDER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CAPITAL CITY BEVERAGES WELFARE PLAN
|
2017
|
640120572
|
2018-09-24
|
CAPITAL CITY BEVERAGES, INC.
|
110
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2007-06-01
|
Business code |
424800
|
Sponsor’s telephone number |
6019562224
|
Plan sponsor’s mailing address |
920 W COUNTY LINE RD, JACKSON, MS, 392139315
|
Plan sponsor’s
address |
920 W COUNTY LINE RD, JACKSON, MS, 392139315
|
Plan administrator’s name and address
Administrator’s EIN |
640120572 |
Plan administrator’s name |
CAPITAL CITY BEVERAGES, INC. |
Plan administrator’s
address |
920 W COUNTY LINE RD, JACKSON, MS, 392139315 |
Administrator’s telephone number |
6019562224 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2018-09-24 |
Name of individual signing |
ROBERT VOLLENWEIDER |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-09-24 |
Name of individual signing |
ROBERT VOLLENWEIDER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CAPITAL CITY BEVERAGES WELFARE PLAN
|
2016
|
640120572
|
2017-10-13
|
CAPITAL CITY BEVERAGES, INC.
|
116
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2007-06-01
|
Business code |
424800
|
Sponsor’s telephone number |
6019562224
|
Plan sponsor’s mailing address |
920 W COUNTY LINE RD, JACKSON, MS, 392139315
|
Plan sponsor’s
address |
920 W COUNTY LINE RD, JACKSON, MS, 392139315
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2017-10-13 |
Name of individual signing |
ROBERT VOLLENWEIDER |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2017-10-13 |
Name of individual signing |
ROBERT VOLLENWEIDER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CAPITAL CITY BEVERAGES WELFARE PLAN
|
2015
|
640120572
|
2016-11-03
|
CAPITAL CITY BEVERAGES, INC.
|
No data
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2007-06-01
|
Business code |
424800
|
Sponsor’s telephone number |
6019562224
|
Plan sponsor’s mailing address |
920 W COUNTY LINE RD, JACKSON, MS, 392139315
|
Plan sponsor’s
address |
920 W COUNTY LINE RD, JACKSON, MS, 392139315
|
Number of participants as of the end of the plan year
Active participants |
108 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2016-11-03 |
Name of individual signing |
ROBERT VOLLENWEIDER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CAPITAL CITY BEVERAGES WELFARE PLAN
|
2015
|
640120572
|
2016-11-03
|
CAPITAL CITY BEVERAGES, INC.
|
108
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2007-06-01
|
Business code |
424800
|
Sponsor’s telephone number |
6019562224
|
Plan sponsor’s mailing address |
920 W COUNTY LINE RD, JACKSON, MS, 392139315
|
Plan sponsor’s
address |
920 W COUNTY LINE RD, JACKSON, MS, 392139315
|
Number of participants as of the end of the plan year
Active participants |
107 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2016-11-03 |
Name of individual signing |
ROBERT VOLLENWEIDER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CAPITAL CITY BEVERAGES WELFARE PLAN
|
2015
|
640120572
|
2016-11-03
|
CAPITAL CITY BEVERAGES, INC.
|
109
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2007-06-01
|
Business code |
424800
|
Sponsor’s telephone number |
6019562224
|
Plan sponsor’s mailing address |
920 W COUNTY LINE RD, JACKSON, MS, 392139315
|
Plan sponsor’s
address |
920 W COUNTY LINE RD, JACKSON, MS, 392139315
|
Number of participants as of the end of the plan year
Active participants |
116 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2016-11-03 |
Name of individual signing |
ROBERT VOLLENWEIDER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CAPITAL CITY BEVERAGES, INC. 401(K) PROFIT SHARING PLAN
|
2015
|
640120572
|
2016-07-05
|
CAPITAL CITY BEVERAGES, INC.
|
104
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2016/07/05/20160705161420P030021872871001.pdf |
Three-digit plan number (PN) |
001 |
Effective date of plan |
2002-09-01 |
Business code |
424800 |
Sponsor’s telephone number |
6019562224 |
Plan sponsor’s
address |
920 W. COUNTY LINE ROAD, JACKSON, MS, 39213 |
Signature of
Role |
Plan administrator |
Date |
2016-07-05 |
Name of individual signing |
ROBERT P VOLLENWEIDER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CAPITAL CITY BEVERAGES WELFARE PLAN
|
2014
|
640120572
|
2016-11-03
|
CAPITAL CITY BEVERAGES, INC.
|
109
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2016/11/03/20161103151219P040050157591001.pdf |
Three-digit plan number (PN) |
501 |
Effective date of plan |
2007-06-01 |
Business code |
424800 |
Sponsor’s telephone number |
6019562224 |
Plan sponsor’s mailing address |
920 W COUNTY LINE RD, JACKSON, MS, 392139315 |
Plan sponsor’s
address |
920 W COUNTY LINE RD, JACKSON, MS, 392139315 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2016-11-03 |
Name of individual signing |
ROBERT VOLLENWEIDER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CAPITAL CITY BEVERAGES, INC. 401(K) PROFIT SHARING PLAN
|
2014
|
640120572
|
2015-05-27
|
CAPITAL CITY BEVERAGES, INC.
|
108
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2015/05/27/20150527163904P030015894535001.pdf |
Three-digit plan number (PN) |
001 |
Effective date of plan |
2002-09-01 |
Business code |
424800 |
Sponsor’s telephone number |
6019562224 |
Plan sponsor’s
address |
920 W. COUNTY LINE ROAD, JACKSON, MS, 39213 |
Signature of
Role |
Plan administrator |
Date |
2015-05-27 |
Name of individual signing |
LEA MATTHEWS |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CAPITAL CITY BEVERAGES WELFARE PLAN
|
2013
|
640120572
|
2016-11-03
|
CAPITAL CITY BEVERAGES, INC.
|
109
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2016/11/03/20161103151259P030052303831001.pdf |
Three-digit plan number (PN) |
501 |
Effective date of plan |
2007-06-01 |
Business code |
424800 |
Sponsor’s telephone number |
6019562224 |
Plan sponsor’s mailing address |
920 W COUNTY LINE RD, JACKSON, MS, 392139315 |
Plan sponsor’s
address |
920 W COUNTY LINE RD, JACKSON, MS, 392139315 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2016-11-03 |
Name of individual signing |
ROBERT VOLLENWEIDER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CAPITAL CITY BEVERAGES, INC. 401(K) PROFIT SHARING PLAN
|
2013
|
640120572
|
2014-06-17
|
CAPITAL CITY BEVERAGES, INC.
|
99
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2014/06/17/20140617134200P040398909027001.pdf |
Three-digit plan number (PN) |
001 |
Effective date of plan |
2002-09-01 |
Business code |
424800 |
Sponsor’s telephone number |
6019562224 |
Plan sponsor’s
address |
920 W. COUNTY LINE ROAD, JACKSON, MS, 39213 |
Signature of
Role |
Plan administrator |
Date |
2014-06-17 |
Name of individual signing |
LEA MATTHEWS |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CAPITAL CITY BEVERAGES WELFARE PLAN
|
2012
|
640120572
|
2016-11-03
|
CAPITAL CITY BEVERAGES, INC.
|
107
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2016/11/03/20161103151342P040050159719001.pdf |
Three-digit plan number (PN) |
501 |
Effective date of plan |
2007-06-01 |
Business code |
424800 |
Sponsor’s telephone number |
6019562224 |
Plan sponsor’s mailing address |
920 W COUNTY LINE RD, JACKSON, MS, 392139315 |
Plan sponsor’s
address |
920 W COUNTY LINE RD, JACKSON, MS, 392139315 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2016-11-03 |
Name of individual signing |
ROBERT VOLLENWEIDER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CAPITAL CITY BEVERAGES, INC. 401(K) PROFIT SHARING PLAN
|
2012
|
640120572
|
2013-05-22
|
CAPITAL CITY BEVERAGES, INC.
|
100
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2013/05/22/20130522141146P030079503461001.pdf |
Three-digit plan number (PN) |
001 |
Effective date of plan |
2002-09-01 |
Business code |
424800 |
Sponsor’s telephone number |
6019562224 |
Plan sponsor’s
address |
920 W. COUNTY LINE ROAD, JACKSON, MS, 39213 |
Signature of
Role |
Plan administrator |
Date |
2013-05-22 |
Name of individual signing |
LEA MATTHEWS |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CAPITAL CITY BEVERAGES, INC. 401(K) PROFIT SHARING PLAN
|
2011
|
640120572
|
2012-10-03
|
CAPITAL CITY BEVERAGES, INC.
|
93
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2012/10/03/20121003100315P040000306518001.pdf |
Three-digit plan number (PN) |
001 |
Effective date of plan |
2002-09-01 |
Business code |
424800 |
Sponsor’s telephone number |
6019562224 |
Plan sponsor’s
address |
920 W. COUNTY LINE ROAD, JACKSON, MS, 39213 |
Plan administrator’s name and address
Administrator’s EIN |
640120572 |
Plan administrator’s name |
CAPITAL CITY BEVERAGES, INC. |
Plan administrator’s
address |
920 W. COUNTY LINE ROAD, JACKSON, MS, 39213 |
Administrator’s telephone number |
6019562224 |
Signature of
Role |
Plan administrator |
Date |
2012-10-03 |
Name of individual signing |
LEA MATTHEWS |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CAPITAL CITY BEVERAGES, INC. 401(K) PROFIT SHARING PLAN
|
2010
|
640120572
|
2011-10-04
|
CAPITAL CITY BEVERAGES, INC.
|
92
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2011/10/04/20111004150334P040656350496001.pdf |
Three-digit plan number (PN) |
001 |
Effective date of plan |
2002-09-01 |
Business code |
424800 |
Sponsor’s telephone number |
6019562224 |
Plan sponsor’s
address |
920 W. COUNTY LINE ROAD, JACKSON, MS, 39213 |
Plan administrator’s name and address
Administrator’s EIN |
640120572 |
Plan administrator’s name |
CAPITAL CITY BEVERAGES, INC. |
Plan administrator’s
address |
920 W. COUNTY LINE ROAD, JACKSON, MS, 39213 |
Administrator’s telephone number |
6019562224 |
Signature of
Role |
Plan administrator |
Date |
2011-10-04 |
Name of individual signing |
FRANK DRENNAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CAPITAL CITY BEVERAGES, INC. 401(K) PROFIT SHARING PLAN
|
2009
|
640120572
|
2010-09-15
|
CAPITAL CITY BEVERAGES, INC.
|
90
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2010/09/15/20100915095337P030500328257001.pdf |
Three-digit plan number (PN) |
001 |
Effective date of plan |
2002-09-01 |
Business code |
424800 |
Sponsor’s telephone number |
6019562224 |
Plan sponsor’s
address |
920 W. COUNTY LINE ROAD, JACKSON, MS, 39213 |
Plan administrator’s name and address
Administrator’s EIN |
640120572 |
Plan administrator’s name |
CAPITAL CITY BEVERAGES, INC. |
Plan administrator’s
address |
920 W. COUNTY LINE ROAD, JACKSON, MS, 39213 |
Administrator’s telephone number |
6019562224 |
Signature of
Role |
Plan administrator |
Date |
2010-09-15 |
Name of individual signing |
FRANK DRENNAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|