ROYAL TIRE INC GROUP VOLUNTARY DENTAL PPO INSURANCE
|
2022
|
410855664
|
2024-04-11
|
ROYAL TIRE INC
|
218
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2008-07-01
|
Business code |
423800
|
Sponsor’s telephone number |
3202573077
|
Plan sponsor’s mailing address |
3955 ROOSEVELT ROAD, ST CLOUD, MN, 56301
|
Plan sponsor’s
address |
3955 ROOSEVELT ROAD, ST CLOUD, MN, 56301
|
Number of participants as of the end of the plan year
Active participants |
0 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2024-04-10 |
Name of individual signing |
PATRICK DUININCK |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2024-04-10 |
Name of individual signing |
PATRICK DUININCK |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
ROYAL TIRE INC EMPLOYEE SECURITY BENEFITS PLAN
|
2022
|
410855664
|
2024-04-11
|
ROYAL TIRE INC
|
118
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2008-07-01
|
Business code |
423800
|
Sponsor’s telephone number |
3202573077
|
Plan sponsor’s mailing address |
3955 ROOSEVELT ROAD, ST CLOUD, MN, 56301
|
Plan sponsor’s
address |
3955 ROOSEVELT ROAD, ST CLOUD, MN, 56301
|
Number of participants as of the end of the plan year
Active participants |
0 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2024-04-10 |
Name of individual signing |
PATRICK DUININCK |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2024-04-10 |
Name of individual signing |
PATRICK DUININCK |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
ROYAL TIRE INC EMPLOYEE SECURITY BENEFITS PLAN
|
2021
|
410855664
|
2023-01-13
|
ROYAL TIRE, INC.
|
114
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2008-07-01
|
Business code |
423800
|
Sponsor’s telephone number |
3202573077
|
Plan
sponsor’s DBA name |
ROYAL TIRE INC
|
Plan sponsor’s mailing address |
3955 ROOSEVELT ROAD, ST CLOUD, MN, 56302
|
Plan sponsor’s
address |
3955 ROOSEVELT ROAD, ST CLOUD, MN, 56301
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2022-11-21 |
Name of individual signing |
LYNN BRAUN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2022-11-21 |
Name of individual signing |
LYNN BRAUN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
ROYAL TIRE INC GROUP VOLUNTARY DENTAL PPO INSURANCE
|
2021
|
410855664
|
2023-01-13
|
ROYAL TIRE INC
|
202
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2008-07-01
|
Business code |
423800
|
Sponsor’s telephone number |
3202573077
|
Plan sponsor’s mailing address |
3955 ROOSEVELT ROAD, ST CLOUD, MN, 56301
|
Plan sponsor’s
address |
3955 ROOSEVELT ROAD, ST CLOUD, MN, 56301
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2022-09-20 |
Name of individual signing |
LYNN BRAUN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2022-09-20 |
Name of individual signing |
LYNN BRAUN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
ROYAL TIRE INC EMPLOYEE SECURITY BENEFITS PLAN
|
2020
|
410855664
|
2021-11-17
|
ROYAL TIRE, INC.
|
119
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2008-07-01
|
Business code |
423800
|
Sponsor’s telephone number |
3202573077
|
Plan
sponsor’s DBA name |
ROYAL TIRE INC
|
Plan sponsor’s mailing address |
3955 ROOSEVELT ROAD, ST CLOUD, MN, 56302
|
Plan sponsor’s
address |
3955 ROOSEVELT ROAD, ST CLOUD, MN, 56301
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2021-11-01 |
Name of individual signing |
LYNN BRAUN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2021-11-01 |
Name of individual signing |
LYNN BRAUN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
ROYAL TIRE INC GROUP VOLUNTARY DENTAL PPO INSURANCE
|
2020
|
410855664
|
2021-11-17
|
ROYAL TIRE INC
|
197
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2008-07-01
|
Business code |
423800
|
Sponsor’s telephone number |
3202573077
|
Plan sponsor’s mailing address |
3955 ROOSEVELT ROAD, ST CLOUD, MN, 56301
|
Plan sponsor’s
address |
3955 ROOSEVELT ROAD, ST CLOUD, MN, 56301
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2021-10-12 |
Name of individual signing |
LYNN BRAUN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2021-10-12 |
Name of individual signing |
LYNN BRAUN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
ROYAL TIRE INC GROUP VOLUNTARY DENTAL PPO INSURANCE
|
2019
|
410855664
|
2020-11-09
|
ROYAL TIRE INC
|
196
|
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2008-07-01
|
Business code |
423800
|
Sponsor’s telephone number |
3202573077
|
Plan sponsor’s mailing address |
3955 ROOSEVELT ROAD, ST CLOUD, MN, 56301
|
Plan sponsor’s
address |
3955 ROOSEVELT ROAD, ST CLOUD, MN, 56301
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2020-09-17 |
Name of individual signing |
LYNN BRAUN |
Valid signature |
Filed with incorrect/unrecognized electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2020-09-17 |
Name of individual signing |
LYNN BRAUN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
ROYAL TIRE INC EMPLOYEE SECURITY BENEFITS PLAN
|
2019
|
410855664
|
2020-11-09
|
ROYAL TIRE, INC.
|
116
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2008-07-01
|
Business code |
423800
|
Sponsor’s telephone number |
3202573077
|
Plan
sponsor’s DBA name |
ROYAL TIRE INC
|
Plan sponsor’s mailing address |
3955 ROOSEVELT ROAD, ST CLOUD, MN, 56302
|
Plan sponsor’s
address |
3955 ROOSEVELT ROAD, ST CLOUD, MN, 56301
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2020-10-20 |
Name of individual signing |
LYNN BRAUN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2020-10-20 |
Name of individual signing |
LYNN BRAUN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
ROYAL TIRE INC GROUP VOLUNTARY DENTAL PPO INSURANCE
|
2019
|
410855664
|
2020-11-11
|
ROYAL TIRE INC
|
196
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2008-07-01
|
Business code |
423800
|
Sponsor’s telephone number |
3202573077
|
Plan sponsor’s mailing address |
3955 ROOSEVELT ROAD, ST CLOUD, MN, 56301
|
Plan sponsor’s
address |
3955 ROOSEVELT ROAD, ST CLOUD, MN, 56301
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2020-09-17 |
Name of individual signing |
LYNN BRAUN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2020-09-17 |
Name of individual signing |
LYNN BRAUN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
ROYAL TIRE INC EMPLOYEE SECURITY BENEFITS PLAN
|
2018
|
410855664
|
2019-10-07
|
ROYAL TIRE, INC.
|
128
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
2008-07-01
|
Business code |
423800
|
Sponsor’s telephone number |
3202573077
|
Plan
sponsor’s DBA name |
ROYAL TIRE INC
|
Plan sponsor’s mailing address |
3955 ROOSEVELT ROAD, ST CLOUD, MN, 56302
|
Plan sponsor’s
address |
3955 ROOSEVELT ROAD, ST CLOUD, MN, 56301
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2019-09-17 |
Name of individual signing |
LYNN BRAUN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2019-09-17 |
Name of individual signing |
LYNN BRAUN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|