K-DUB RACING, INC. EMPLOYEE WELFARE BENEFIT PLAN
|
2015
|
330922077
|
2017-05-15
|
K-DUB RACING, INC.
|
1
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2000-08-01
|
Business code |
711510
|
Sponsor’s telephone number |
6016455732
|
Plan sponsor’s
address |
P. O. BOX 249, CENTREVILLE, MS, 39631
|
Signature of
Role |
Plan administrator |
Date |
2017-05-15 |
Name of individual signing |
KEVIN W. WINDHAM |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
K-DUB RACING, INC. EMPLOYEE WELFARE BENEFIT PLAN
|
2014
|
330922077
|
2016-05-16
|
K-DUB RACING, INC.
|
1
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2000-08-01
|
Business code |
711510
|
Sponsor’s telephone number |
6016455732
|
Plan sponsor’s
address |
P. O. BOX 249, CENTREVILLE, MS, 39631
|
Signature of
Role |
Plan administrator |
Date |
2016-05-16 |
Name of individual signing |
KEVIN W. WINDHAM |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
K-DUB RACING, INC. EMPLOYEE WELFARE BENEFIT PLAN
|
2013
|
330922077
|
2015-05-14
|
K-DUB RACING, INC.
|
1
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2000-08-01
|
Business code |
711510
|
Sponsor’s telephone number |
6016455732
|
Plan sponsor’s
address |
P. O. BOX 249, CENTREVILLE, MS, 396310249
|
Signature of
Role |
Plan administrator |
Date |
2015-05-14 |
Name of individual signing |
KEVIN W. WINDHAM |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2015-05-14 |
Name of individual signing |
KEVIN W. WINDHAM |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
K-DUB RACING, INC. EMPLOYEE WELFARE BENEFIT PLAN
|
2012
|
330922077
|
2014-05-14
|
K-DUB RACING, INC.
|
1
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2000-08-01
|
Business code |
711510
|
Sponsor’s telephone number |
6016455034
|
Plan sponsor’s
address |
P. O. BOX 249, CENTREVILLE, MS, 396310249
|
Signature of
Role |
Plan administrator |
Date |
2014-05-14 |
Name of individual signing |
KEVIN W. WINDHAM |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
K-DUB RACING, INC. EMPLOYEE WELFARE BENEFIT PLAN
|
2011
|
330922077
|
2013-05-14
|
K-DUB RACING, INC.
|
1
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2000-08-01
|
Business code |
711510
|
Sponsor’s telephone number |
6016455732
|
Plan sponsor’s
address |
P.O. BOX 249, CENTREVILLE, MS, 396310249
|
Plan administrator’s name and address
Administrator’s EIN |
330922077 |
Plan administrator’s name |
K-DUB RACING, INC. |
Plan administrator’s
address |
P.O. BOX 249, CENTREVILLE, MS, 396310249 |
Administrator’s telephone number |
6016455732 |
Signature of
Role |
Plan administrator |
Date |
2013-05-14 |
Name of individual signing |
KEVIN W. WINDHAM |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
K-DUB RACING, INC. EMPLOYEE WELFARE BENEFIT PLAN
|
2010
|
330922077
|
2012-04-11
|
K-DUB RACING, INC.
|
1
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2000-08-01
|
Business code |
711510
|
Sponsor’s telephone number |
6016455732
|
Plan sponsor’s
address |
P.O. BOX 249, CENTREVILLE, MS, 396310249
|
Plan administrator’s name and address
Administrator’s EIN |
330922077 |
Plan administrator’s name |
K-DUB RACING, INC. |
Plan administrator’s
address |
P.O. BOX 249, CENTREVILLE, MS, 396310249 |
Administrator’s telephone number |
6016455732 |
Signature of
Role |
Plan administrator |
Date |
2012-04-11 |
Name of individual signing |
KEVIN W. WINDHAM |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
K-DUB RACING, INC. EMPLOYEE WELFARE BENEFIT PLAN
|
2009
|
330922077
|
2011-05-24
|
K-DUB RACING, INC.
|
1
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2000-08-01
|
Business code |
711510
|
Sponsor’s telephone number |
6016455732
|
Plan sponsor’s
address |
P.O. BOX 249, CENTREVILLE, MS, 396310249
|
Plan administrator’s name and address
Administrator’s EIN |
330922077 |
Plan administrator’s name |
K-DUB RACING, INC. |
Plan administrator’s
address |
P.O. BOX 249, CENTREVILLE, MS, 396310249 |
Administrator’s telephone number |
6016455732 |
Signature of
Role |
Plan administrator |
Date |
2011-05-24 |
Name of individual signing |
KEVIN W. WINDHAM |
Valid signature |
Filed with authorized/valid electronic signature |
|
|