|
HIBBS INSURANCE AGENCY 401(K) PLAN
|
2023
|
611328699
|
2024-10-11
|
HIBBS INSURANCE AGENCY, INC.
|
8
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2020-01-01
|
| Business code |
524210
|
| Sponsor’s telephone number |
2705542105
|
| Plan sponsor’s
address |
3124 LONE OAK ROAD, PADUCAH, KY, 42003
|
Signature of
| Role |
Plan administrator |
| Date |
2024-10-11 |
| Name of individual signing |
JASON HIBBS |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
HIBBS INSURANCE AGENCY INC MEDOVA LIFESTYLE HEALTH PLAN
|
2022
|
611328699
|
2023-06-30
|
HIBBS INSURANCE AGENCY INC
|
0
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2021-12-01
|
| Business code |
524210
|
| Sponsor’s telephone number |
2705542105
|
| Plan sponsor’s
address |
3124 LONE OAK RD, PADUCAH, KY, 420035744
|
Plan administrator’s name and address
| Administrator’s EIN |
200200514 |
| Plan administrator’s name |
RECEIVERSHIP MANAGEMENT INC |
| Plan administrator’s
address |
510 HOSPITAL DR STE 490, MADISON, TN, 371155049 |
| Administrator’s telephone number |
6153700051 |
Signature of
| Role |
Plan administrator |
| Date |
2023-06-30 |
| Name of individual signing |
ROBERT MOORE |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
HIBBS INSURANCE AGENCY 401(K) PLAN
|
2022
|
611328699
|
2023-10-13
|
HIBBS INSURANCE AGENCY, INC.
|
8
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2020-01-01
|
| Business code |
524210
|
| Sponsor’s telephone number |
2705542105
|
| Plan sponsor’s
address |
3124 LONE OAK ROAD, PADUCAH, KY, 42003
|
Signature of
| Role |
Plan administrator |
| Date |
2023-10-13 |
| Name of individual signing |
JASON HIBBS |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
HIBBS INSURANCE AGENCY 401(K) PLAN
|
2021
|
611328699
|
2022-10-15
|
HIBBS INSURANCE AGENCY, INC.
|
8
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2020-01-01
|
| Business code |
524210
|
| Sponsor’s telephone number |
2705542105
|
| Plan sponsor’s
address |
3124 LONE OAK ROAD, PADUCAH, KY, 42003
|
Signature of
| Role |
Plan administrator |
| Date |
2022-10-15 |
| Name of individual signing |
JASON HIBBS |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
HIBBS INSURANCE AGENCY INC MEDOVA LIFESTYLE HEALTH PLAN
|
2021
|
611328699
|
2022-09-30
|
HIBBS INSURANCE AGENCY INC
|
2
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2021-01-01
|
| Business code |
524210
|
| Sponsor’s telephone number |
2705542105
|
| Plan sponsor’s
address |
3124 LONE OAK RD, PADUCAH, KY, 420035744
|
Plan administrator’s name and address
| Administrator’s EIN |
200200514 |
| Plan administrator’s name |
RECEIVERSHIP MANAGEMENT INC |
| Plan administrator’s
address |
510 HOSPITAL DR STE 490, MADISON, TN, 371155049 |
| Administrator’s telephone number |
6153700051 |
Signature of
| Role |
Plan administrator |
| Date |
2022-09-29 |
| Name of individual signing |
ROBERT MOORE |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
HIBBS INSURANCE AGENCY 401(K) PLAN
|
2020
|
611328699
|
2021-10-01
|
HIBBS INSURANCE AGENCY, INC.
|
0
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2020-01-01
|
| Business code |
524210
|
| Sponsor’s telephone number |
2705542105
|
| Plan sponsor’s
address |
3124 LONE OAK ROAD, PADUCAH, KY, 42003
|
Signature of
| Role |
Plan administrator |
| Date |
2021-10-01 |
| Name of individual signing |
JASON HIBBS |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
