BOOM ENTERPRISES LLC

Company Details

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

BOOM ENTERPRISES LLC EMPLOYEE GROUP HEALTH PLAN

2021

300399993

2022-06-28

BOOM ENTERPRISES LLC

Plan administrator’s name and address

Administrator’s EIN	300399993
Plan administrator’s name	BOOM ENTERPRISES LLC
Plan administrator’s address	1540 E DUNDEE RD STE 320, PALATINE, IL, 600748316
Administrator’s telephone number	8479079660

Signature of

Role	Plan administrator
Date	2022-06-28
Name of individual signing	MARK NEWBURGER
Valid signature	Filed with authorized/valid electronic signature

Role	Employer/plan sponsor
Date	2022-06-28
Name of individual signing	MARK NEWBURGER
Valid signature	Filed with authorized/valid electronic signature

BOOM ENTERPRISES LLC EMPLOYEE GROUP HEALTH PLAN

2016

300399993

2017-06-14

BOOM ENTERPRISES LLC

Signature of

Role	Plan administrator
Date	2017-06-14
Name of individual signing	MARK NEWBURGER
Valid signature	Filed with authorized/valid electronic signature

Name and Address	Role	Appointment Date
KENNETH H BROWN, 135 REVERE DR, NORTHBROOK, 60062, LAKE	Agent	2020-12-03

Name and Address	Role	Appointment Date
WOLKEN, HAL R, 1540 DUNDEE RD., #320, PALATINE, IL, 60074	Manager	2019-12-31

Date of last update: 23 Dec 2024