|
IMPACT COLLISION CBS BENEFIT PLAN
|
2021
|
831226880
|
2022-12-29
|
IMPACT COLLISION
|
4
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2020-09-01
|
| Business code |
811110
|
| Sponsor’s telephone number |
6066798000
|
| Plan sponsor’s
address |
108 SOUTHERN SCHOOL RD, SOMERSET, KY, 42501
|
Plan administrator’s name and address
| Administrator’s EIN |
846429706 |
| Plan administrator’s name |
SHAWNA BURTON |
| Plan administrator’s
address |
464 CHENAULT RD, FRANKFORT, KY, 40601 |
| Administrator’s telephone number |
5026954700 |
Signature of
| Role |
Plan administrator |
| Date |
2022-12-29 |
| Name of individual signing |
SHAWNA BURTON |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
IMPACT COLLISION CBS BENEFIT PLAN
|
2020
|
831226880
|
2021-12-14
|
IMPACT COLLISION
|
3
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2020-09-01
|
| Business code |
811110
|
| Sponsor’s telephone number |
6066798000
|
| Plan sponsor’s
address |
108 SOUTHERN SCHOOL RD, SOMERSET, KY, 42501
|
Plan administrator’s name and address
| Administrator’s EIN |
846429706 |
| Plan administrator’s name |
SHAWNA BURTON |
| Plan administrator’s
address |
464 CHENAULT RD, FRANKFORT, KY, 40601 |
| Administrator’s telephone number |
5026954700 |
Signature of
| Role |
Plan administrator |
| Date |
2021-12-14 |
| Name of individual signing |
SHAWNA BURTON |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
