PETTY & BIELIK ORTHODONTICS, P. C. 401(K) PROFIT SHARING PLAN
|
2020
|
362809686
|
2021-08-11
|
PETTY & BIELIK ORTHODONTICS, P.C.
|
44
|
|
File |
View Page
|
Three-digit plan number (PN) |
005
|
Effective date of plan |
1983-11-01
|
Business code |
621210
|
Sponsor’s telephone number |
7086362900
|
Plan sponsor’s
address |
4233 WEST 95TH STREET, OAK LAWN, IL, 60453
|
Signature of
Role |
Plan administrator |
Date |
2021-08-11 |
Name of individual signing |
KATHRYN BIELIK |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2021-08-11 |
Name of individual signing |
KATHRYN BIELIK |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
PETTY & BIELIK ORTHODONTICS, P.C. 401(K) PROFIT SHARING PLAN
|
2019
|
362809686
|
2020-09-21
|
PETTY & BIELIK ORTHODONTICS, P.C.
|
43
|
|
File |
View Page
|
Three-digit plan number (PN) |
005
|
Effective date of plan |
1983-11-01
|
Business code |
621210
|
Sponsor’s telephone number |
7086362900
|
Plan sponsor’s
address |
4233 W. 95TH ST., OAK LAWN, IL, 60453
|
Signature of
Role |
Plan administrator |
Date |
2020-09-21 |
Name of individual signing |
KATHRYN BIELIK |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
PETTY, BIELIK & BURKE ORTHODONTICS, P.C. 401(K) PROFIT SHARING PLAN
|
2018
|
362809686
|
2019-07-29
|
PETTY, BIELIK & BURKE ORTHODONTICS, P.C.
|
42
|
|
File |
View Page
|
Three-digit plan number (PN) |
005
|
Effective date of plan |
1983-11-01
|
Business code |
621210
|
Sponsor’s telephone number |
7086362900
|
Plan sponsor’s
address |
4233 W. 95TH ST., OAK LAWN, IL, 60453
|
Signature of
Role |
Plan administrator |
Date |
2019-07-29 |
Name of individual signing |
KATHRYN BIELIK |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
PETTY, BIELIK & BURKE ORTHODONTICS, P.C. 401(K) PROFIT SHARING PLAN
|
2017
|
362809686
|
2018-09-11
|
PETTY, BIELIK & BURKE ORTHODONTICS, P.C.
|
44
|
|
File |
View Page
|
Three-digit plan number (PN) |
005
|
Effective date of plan |
1983-11-01
|
Business code |
541990
|
Sponsor’s telephone number |
7086362900
|
Plan sponsor’s
address |
4233 W. 95TH ST., OAK LAWN, IL, 60453
|
Signature of
Role |
Plan administrator |
Date |
2018-09-11 |
Name of individual signing |
KELLY MCCLELLAND |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
PETTY, BIELIK & BURKE ORTHODONTICS, P.C. 401(K) PROFIT SHARING PLAN
|
2016
|
362809686
|
2017-07-18
|
PETTY, BIELIK & BURKE ORTHODONTICS, P.C.
|
45
|
|
File |
View Page
|
Three-digit plan number (PN) |
005
|
Effective date of plan |
1983-11-01
|
Business code |
541990
|
Sponsor’s telephone number |
7086362900
|
Plan sponsor’s
address |
4233 W. 95TH ST., OAK LAWN, IL, 60453
|
Signature of
Role |
Plan administrator |
Date |
2017-07-18 |
Name of individual signing |
KELLY MCCLELLAND |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
PETTY, BIELIK & BURKE ORTHODONTICS, P.C. 401(K) PROFIT SHARING PLAN
|
2015
|
362809686
|
2016-07-20
|
PETTY, BIELIK & BURKE ORTHODONTICS, P.C.
|
43
|
|
File |
View Page
|
Three-digit plan number (PN) |
005
|
Effective date of plan |
1983-11-01
|
Business code |
541990
|
Sponsor’s telephone number |
7086362900
|
Plan sponsor’s
address |
4233 W. 95TH ST., OAK LAWN, IL, 60453
|
Signature of
Role |
Plan administrator |
Date |
2016-07-20 |
Name of individual signing |
KELLY MCCLELLAND |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
PETTY, BIELIK & BURKE ORTHODONTICS, P.C. 401(K) PROFIT SHARING PLAN
|
2014
|
362809686
|
2015-10-12
|
PETTY, BIELIK & BURKE ORTHODONTICS, P.C.
|
44
|
|
File |
View Page
|
Three-digit plan number (PN) |
005
|
Effective date of plan |
1983-11-01
|
Business code |
541990
|
Sponsor’s telephone number |
7086362900
|
Plan sponsor’s
address |
4233 W. 95TH ST., OAK LAWN, IL, 60453
|
Signature of
Role |
Plan administrator |
Date |
2015-10-12 |
Name of individual signing |
KELLY MCCLELLAND |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
PETTY, BIELIK & BURKE ORTHODONTICS, P.C. 401(K) PROFIT SHARING PLAN
|
2013
|
362809686
|
2014-10-07
|
PETTY, BIELIK & BURKE ORTHODONTICS, P.C.
|
42
|
|
File |
View Page
|
Three-digit plan number (PN) |
005
|
Effective date of plan |
1983-11-01
|
Business code |
541990
|
Sponsor’s telephone number |
7086362900
|
Plan sponsor’s
address |
4233 W. 95TH ST., OAK LAWN, IL, 60453
|
Signature of
Role |
Plan administrator |
Date |
2014-10-07 |
Name of individual signing |
DEBRA SPITZER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
PETTY, BIELIK & BURKE ORTHODONTICS, P.C. 401(K) PROFIT SHARING PLAN
|
2012
|
362809686
|
2013-04-02
|
PETTY, BIELIK & BURKE ORTHODONTICS, P.C.
|
43
|
|
File |
View Page
|
Three-digit plan number (PN) |
005
|
Effective date of plan |
1983-11-01
|
Business code |
541990
|
Sponsor’s telephone number |
7086362900
|
Plan sponsor’s
address |
4233 W. 95TH ST., OAK LAWN, IL, 60453
|
Signature of
Role |
Plan administrator |
Date |
2013-04-01 |
Name of individual signing |
DEBRA SPITZER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
PETTY, BIELIK & BURKE ORTHODONTICS, P.C. 401(K) PROFIT SHARING PLAN
|
2011
|
362809686
|
2012-10-12
|
PETTY, BIELIK & BURKE ORTHODONTICS, P.C.
|
43
|
|
File |
View Page
|
Three-digit plan number (PN) |
005
|
Effective date of plan |
1983-11-01
|
Business code |
541990
|
Sponsor’s telephone number |
7086362900
|
Plan sponsor’s
address |
4233 W. 95TH ST., OAK LAWN, IL, 60453
|
Plan administrator’s name and address
Administrator’s EIN |
362809686 |
Plan administrator’s name |
PETTY, BIELIK & BURKE ORTHODONTICS, P.C. |
Plan administrator’s
address |
4233 W. 95TH ST., OAK LAWN, IL, 60453 |
Administrator’s telephone number |
7086362900 |
Signature of
Role |
Plan administrator |
Date |
2012-10-11 |
Name of individual signing |
DEBRA SPITZER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|