CROFT LLC GROUP MEDICAL INSURANCE HRLY PROGRAM
|
2023
|
753079864
|
2024-07-30
|
CROFT LLC
|
103
|
|
File |
View Page
|
Three-digit plan number (PN) |
504
|
Effective date of plan |
2015-01-01
|
Business code |
332900
|
Sponsor’s telephone number |
6016846121
|
Plan sponsor’s mailing address |
PO BOX 826, MCCOMB, MS, 396490826
|
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2024-07-30 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2024-07-30 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC
|
2022
|
640370477
|
2023-12-29
|
CROFT LLC
|
27
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2016-06-01
|
Business code |
332900
|
Sponsor’s telephone number |
6016846121
|
Plan sponsor’s mailing address |
PO BOX 826, MCCOMB, MS, 396490826
|
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39468
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2023-12-29 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC
|
2022
|
640370477
|
2023-12-29
|
CROFT LLC
|
210
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2016-06-01
|
Business code |
332900
|
Sponsor’s telephone number |
6016846121
|
Plan sponsor’s mailing address |
PO BOX 826, MCCOMB, MS, 396490826
|
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2023-12-29 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC GROUP MEDICAL INSURANCE HRLY PROGRAM
|
2022
|
753079864
|
2023-07-28
|
CROFT LLC
|
124
|
|
File |
View Page
|
Three-digit plan number (PN) |
504
|
Effective date of plan |
2015-01-01
|
Business code |
332900
|
Sponsor’s telephone number |
6016846121
|
Plan
sponsor’s DBA name |
CROFT LLC
|
Plan sponsor’s mailing address |
PO BOX 826, MCCOMB, MS, 396490826
|
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2023-07-28 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC
|
2021
|
640370477
|
2022-12-30
|
CROFT LLC
|
226
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2016-06-01
|
Business code |
332900
|
Sponsor’s telephone number |
6016846121
|
Plan sponsor’s mailing address |
PO BOX 826, MCCOMB, MS, 396490826
|
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2022-12-30 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC
|
2021
|
640370477
|
2022-12-30
|
CROFT LLC
|
28
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2016-06-01
|
Business code |
332900
|
Sponsor’s telephone number |
6016846121
|
Plan sponsor’s mailing address |
PO BOX 826, MCCOMB, MS, 396490826
|
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2022-12-30 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC GROUP MEDICAL INSURANCE HRLY PROGRAM
|
2021
|
640370477
|
2022-07-29
|
CROFT LLC
|
165
|
|
File |
View Page
|
Three-digit plan number (PN) |
504
|
Effective date of plan |
2015-01-01
|
Business code |
332900
|
Sponsor’s telephone number |
6016846121
|
Plan sponsor’s mailing address |
PO BOX 826, MCCOMB, MS, 396490826
|
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2022-07-29 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2022-07-29 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC
|
2020
|
640370477
|
2021-12-27
|
CROFT LLC
|
36
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2016-06-01
|
Business code |
332900
|
Sponsor’s telephone number |
6016846121
|
Plan sponsor’s mailing address |
PO BOX 826, MCCOMB, MS, 396490826
|
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2021-12-27 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC
|
2020
|
640370477
|
2021-12-27
|
CROFT LLC
|
262
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2016-06-01
|
Business code |
332900
|
Sponsor’s telephone number |
6016846121
|
Plan
sponsor’s DBA name |
CROFT LLC
|
Plan sponsor’s mailing address |
PO BOX 826, MCCOMB, MS, 396490826
|
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2021-12-27 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC GROUP MEDICAL INSURANCE HRLY PROGRAM
|
2020
|
640370477
|
2021-07-29
|
CROFT LLC
|
146
|
|
File |
View Page
|
Three-digit plan number (PN) |
504
|
Effective date of plan |
2015-01-01
|
Business code |
332900
|
Sponsor’s telephone number |
6016846121
|
Plan sponsor’s mailing address |
PO BOX 826, MCCOMB, MS, 396490826
|
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2021-07-29 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2021-07-29 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC
|
2019
|
640370477
|
2020-12-22
|
CROFT LLC
|
253
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2020/12/22/20201222124538NAL0009765824001.pdf |
Three-digit plan number (PN) |
501 |
Effective date of plan |
2016-06-01 |
Business code |
332900 |
Sponsor’s telephone number |
0616846121 |
Plan sponsor’s mailing address |
PO BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2020-12-22 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC
|
2019
|
640370477
|
2020-12-22
|
CROFT LLC
|
35
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2020/12/22/20201222120629NAL0009751200001.pdf |
Three-digit plan number (PN) |
502 |
Effective date of plan |
2016-06-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
PO BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2020-12-22 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC GROUP MEDICAL INSURANCE HRLY PROGRAM
|
2019
|
640370477
|
2020-07-24
|
CROFT LLC
|
154
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2020/07/24/20200724161903NAL0004424497001.pdf |
Three-digit plan number (PN) |
504 |
Effective date of plan |
2015-01-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
PO BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2020-07-24 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC
|
2018
|
640370477
|
2019-12-23
|
CROFT LLC
|
251
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2019/12/23/20191223093815P040168204813001.pdf |
Three-digit plan number (PN) |
501 |
Effective date of plan |
2016-06-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
PO BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2019-12-23 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC
|
2018
|
640370477
|
2019-12-23
|
CROFT LLC
|
37
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2019/12/23/20191223093953P040168207293001.pdf |
Three-digit plan number (PN) |
502 |
Effective date of plan |
2016-06-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
PO BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2019-12-23 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC GROUP MEDICAL INSURANCE HRLY PROGRAM
|
2018
|
640370477
|
2019-07-24
|
CROFT LLC
|
144
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2019/07/24/20190724105322P040383079047001.pdf |
Three-digit plan number (PN) |
504 |
Effective date of plan |
2015-01-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
PO BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2019-07-24 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC
|
2017
|
640370477
|
2018-12-17
|
CROFT LLC
|
265
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2018/12/17/20181217162443P030108826663001.pdf |
Three-digit plan number (PN) |
501 |
Effective date of plan |
2016-06-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
PO BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2018-12-17 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-12-17 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC
|
2017
|
640370477
|
2018-12-17
|
CROFT LLC
|
48
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2018/12/17/20181217162412P030108825559001.pdf |
Three-digit plan number (PN) |
502 |
Effective date of plan |
2016-06-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
PO BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2018-12-17 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-12-17 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC GROUP MEDICAL INSURANCE HRLY PROGRAM
|
2017
|
640370477
|
2018-07-25
|
CROFT LLC
|
176
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2018/07/25/20180725132335P030084706241001.pdf |
Three-digit plan number (PN) |
504 |
Effective date of plan |
2015-01-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
PO BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2018-07-25 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC
|
2016
|
640370477
|
2017-12-28
|
CROFT LLC
|
48
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2017/12/28/20171228191455P030356855137001.pdf |
Three-digit plan number (PN) |
502 |
Effective date of plan |
2016-06-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan
sponsor’s DBA name |
CROFT LLC |
Plan sponsor’s mailing address |
PO BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2017-12-28 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2017-12-28 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC
|
2016
|
640370477
|
2017-12-28
|
CROFT LLC
|
273
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2017/12/28/20171228191301P040337900551001.pdf |
Three-digit plan number (PN) |
501 |
Effective date of plan |
2016-06-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
PO BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2017-12-28 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2017-12-28 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC GROUP MEDICAL INSURANCE HRLY PROGRAM
|
2016
|
640370477
|
2017-07-18
|
CROFT LLC
|
184
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2017/07/18/20170718153830P040047991943001.pdf |
Three-digit plan number (PN) |
504 |
Effective date of plan |
2015-01-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
PO BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2017-07-18 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2017-07-18 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC GROUP MEDICAL INSURANCE HRLY PROGRAM
|
2015
|
640370477
|
2016-12-28
|
CROFT LLC
|
214
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2016/12/28/20161228190121P040012017773001.pdf |
Three-digit plan number (PN) |
504 |
Effective date of plan |
2015-01-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
PO BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2016-12-28 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2016-12-28 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC GROUP DENTAL INSURANCE
|
2015
|
640370477
|
2016-12-28
|
CROFT LLC
|
56
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2016/12/28/20161228190031P040012016701001.pdf |
Three-digit plan number (PN) |
503 |
Effective date of plan |
1983-07-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
PO BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2016-12-28 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2016-12-28 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC GROUP MEDICAL INSURANCE PROGRAM
|
2015
|
640370477
|
2016-12-28
|
CROFT LLC
|
55
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2016/12/28/20161228185934P030013134225001.pdf |
Three-digit plan number (PN) |
502 |
Effective date of plan |
1982-05-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
PO BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2016-12-28 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2016-12-28 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC GROUP INSURANCE PLAN
|
2015
|
640370477
|
2016-12-28
|
CROFT LLC
|
325
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2016/12/28/20161228185814P040012013725001.pdf |
Three-digit plan number (PN) |
501 |
Effective date of plan |
1968-01-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
PO BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2016-12-28 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2016-12-28 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC GROUP DENTAL INSURANCE
|
2014
|
640370477
|
2015-12-31
|
CROFT LLC
|
54
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2015/12/31/20151231185623P040145042897001.pdf |
Three-digit plan number (PN) |
503 |
Effective date of plan |
1983-07-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
P O BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2015-12-31 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2015-12-31 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC GROUP MEDICAL INSURANCE PROGRAM
|
2014
|
640370477
|
2015-12-31
|
CROFT LLC
|
187
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2015/12/31/20151231185558P040145042177001.pdf |
Three-digit plan number (PN) |
502 |
Effective date of plan |
1982-05-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
P O BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2015-12-31 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2015-12-31 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC GROUP INSURANCE PLAN
|
2014
|
640370477
|
2015-12-31
|
CROFT LLC
|
267
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2015/12/31/20151231185523P040145041521001.pdf |
Three-digit plan number (PN) |
501 |
Effective date of plan |
1968-01-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
P O BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2015-12-31 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2015-12-31 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC GROUP DENTAL INSURANCE
|
2013
|
640370477
|
2014-12-30
|
CROFT LLC
|
48
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2014/12/30/20141230194256P040024328663001.pdf |
Three-digit plan number (PN) |
503 |
Effective date of plan |
1983-07-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
P O BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2014-12-30 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2014-12-30 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC GROUP MEDICAL INSURANCE PROGRAM
|
2013
|
640370477
|
2014-12-30
|
CROFT LLC
|
170
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2014/12/30/20141230194234P030032788625001.pdf |
Three-digit plan number (PN) |
502 |
Effective date of plan |
1982-05-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
P O BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2014-12-30 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2014-12-30 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC GROUP INSURANCE PLAN
|
2013
|
640370477
|
2014-12-30
|
CROFT LLC
|
235
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2014/12/30/20141230194158P030032787809001.pdf |
Three-digit plan number (PN) |
501 |
Effective date of plan |
1968-01-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
P O BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 39648 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2014-12-30 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2014-12-30 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC GROUP DENTAL INSURANCE
|
2012
|
640370477
|
2013-12-31
|
CROFT LLC
|
52
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2013/12/31/20131231152822P030149949427001.pdf |
Three-digit plan number (PN) |
503 |
Effective date of plan |
1983-07-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
P O BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 396486317 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2013-12-31 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC GROUP MEDICAL INSURANCE PROGRAM
|
2012
|
640370477
|
2013-12-31
|
CROFT LLC
|
165
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2013/12/31/20131231152810P030149949363001.pdf |
Three-digit plan number (PN) |
502 |
Effective date of plan |
1982-05-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
P O BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 396486317 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2013-12-31 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT LLC GROUP INSURANCE PLAN
|
2012
|
640370477
|
2013-12-31
|
CROFT LLC
|
237
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2013/12/31/20131231152744P030149948979001.pdf |
Three-digit plan number (PN) |
501 |
Effective date of plan |
1968-01-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
P O BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 396486317 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2013-12-31 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT, LLC GROUP DENTAL INSURANCE
|
2011
|
640370477
|
2012-12-27
|
CROFT, LLC
|
55
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2012/12/27/20121227163829P040008813317001.pdf |
Three-digit plan number (PN) |
503 |
Effective date of plan |
1983-07-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
P O BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 396486317 |
Plan administrator’s name and address
Administrator’s EIN |
640370477 |
Plan administrator’s name |
CROFT, LLC |
Plan administrator’s
address |
P O BOX 826, MCCOMB, MS, 396490826 |
Administrator’s telephone number |
6016846121 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2012-12-27 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT, LLC GROUP MEDICAL INSURANCE PROGRAM
|
2011
|
640370477
|
2012-12-27
|
CROFT LLC
|
176
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2012/12/27/20121227163753P040008812981001.pdf |
Three-digit plan number (PN) |
502 |
Effective date of plan |
1982-05-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
P O BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 396486317 |
Plan administrator’s name and address
Administrator’s EIN |
640370477 |
Plan administrator’s name |
CROFT LLC |
Plan administrator’s
address |
P O BOX 826, MCCOMB, MS, 396490826 |
Administrator’s telephone number |
6016846121 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2012-12-27 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT, LLC GROUP INSURANCE PLAN
|
2011
|
640370477
|
2012-12-27
|
CROFT, LLC
|
238
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2012/12/27/20121227163526P040008811941001.pdf |
Three-digit plan number (PN) |
501 |
Effective date of plan |
1968-01-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
P O BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 396486317 |
Plan administrator’s name and address
Administrator’s EIN |
640370477 |
Plan administrator’s name |
CROFT, LLC |
Plan administrator’s
address |
P O BOX 826, MCCOMB, MS, 396490826 |
Administrator’s telephone number |
6016846121 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2012-12-27 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT, LLC GROUP INSURANCE PLAN
|
2010
|
640370477
|
2012-02-29
|
CROFT, LLC
|
255
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2012/02/29/20120229145714P030044544081001.pdf |
Three-digit plan number (PN) |
501 |
Effective date of plan |
1968-01-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
P O BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 396486317 |
Plan administrator’s name and address
Administrator’s EIN |
640370477 |
Plan administrator’s name |
CROFT, LLC |
Plan administrator’s
address |
P O BOX 826, MCCOMB, MS, 396490826 |
Administrator’s telephone number |
6016846121 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2012-02-29 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT, LLC GROUP DENTAL INSURANCE
|
2010
|
640370477
|
2012-02-29
|
CROFT, LLC
|
61
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2012/02/29/20120229145651P030044543985001.pdf |
Three-digit plan number (PN) |
503 |
Effective date of plan |
1983-07-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
P O BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 396486317 |
Plan administrator’s name and address
Administrator’s EIN |
640370477 |
Plan administrator’s name |
CROFT, LLC |
Plan administrator’s
address |
P O BOX 826, MCCOMB, MS, 396490826 |
Administrator’s telephone number |
6016846121 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2012-02-29 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT, LLC GROUP MEDICAL INSURANCE PROGRAM
|
2010
|
640370477
|
2012-02-29
|
CROFT LLC
|
186
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2012/02/29/20120229145450P030044543537001.pdf |
Three-digit plan number (PN) |
502 |
Effective date of plan |
1982-05-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
P O BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 396486317 |
Plan administrator’s name and address
Administrator’s EIN |
640370477 |
Plan administrator’s name |
CROFT LLC |
Plan administrator’s
address |
P O BOX 826, MCCOMB, MS, 396490826 |
Administrator’s telephone number |
6016846121 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2012-02-29 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT, LLC GROUP MEDICAL INSURANCE PROGRAM
|
2009
|
640370477
|
2010-12-28
|
CROFT, LLC
|
187
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2010/12/28/20101228105314P030000762658001.pdf |
Three-digit plan number (PN) |
502 |
Effective date of plan |
1982-05-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
P O BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 396486317 |
Plan administrator’s name and address
Administrator’s EIN |
640370477 |
Plan administrator’s name |
CROFT, LLC |
Plan administrator’s
address |
P O BOX 826, MCCOMB, MS, 396490826 |
Administrator’s telephone number |
6016846121 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2010-12-28 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT, LLC GROUP INSURANCE PLAN
|
2009
|
640370477
|
2010-12-28
|
CROFT, LLC
|
265
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2010/12/28/20101228104011P040021209616001.pdf |
Three-digit plan number (PN) |
501 |
Effective date of plan |
1968-01-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
P O BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 396486317 |
Plan administrator’s name and address
Administrator’s EIN |
640370477 |
Plan administrator’s name |
CROFT, LLC |
Plan administrator’s
address |
P O BOX 826, MCCOMB, MS, 396490826 |
Administrator’s telephone number |
6016846121 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2010-12-28 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
CROFT, LLC GROUP DENTAL INSURANCE PROGRAM
|
2009
|
640370477
|
2010-12-28
|
CROFT, LLC
|
64
|
|
File |
https://efast2-filings-public.s3.amazonaws.com/prd/2010/12/28/20101228110319P030000763458001.pdf |
Three-digit plan number (PN) |
503 |
Effective date of plan |
1983-07-01 |
Business code |
332900 |
Sponsor’s telephone number |
6016846121 |
Plan sponsor’s mailing address |
P O BOX 826, MCCOMB, MS, 396490826 |
Plan sponsor’s
address |
107 OLIVER EMMERICH DRIVE, MCCOMB, MS, 396486317 |
Plan administrator’s name and address
Administrator’s EIN |
640370477 |
Plan administrator’s name |
CROFT, LLC |
Plan administrator’s
address |
P O BOX 826, MCCOMB, MS, 396490826 |
Administrator’s telephone number |
6016846121 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2010-12-28 |
Name of individual signing |
GERALD ABDALLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|