TOWN SQUARE ANESTHESIA, LLC CASH BALANCE PENSION PLAN & TRUST
|
2012
|
300202393
|
2013-10-08
|
TOWN SQUARE ANESTHESIA, LLC
|
6
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
2010-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8153343170
|
Plan sponsor’s
address |
3703 DOTY ROAD, SUITE 7, WOODSTOCK, IL, 60098
|
Signature of
Role |
Plan administrator |
Date |
2013-10-08 |
Name of individual signing |
WILLIAM WEEMS |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-10-08 |
Name of individual signing |
WILLIAM WEEMS |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
TOWN SQUARE ANESTHESIA, LLC CASH BALANCE PENSION PLAN & TRUST
|
2011
|
300202393
|
2012-10-11
|
TOWN SQUARE ANESTHESIA, LLC
|
5
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
2010-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8153343170
|
Plan sponsor’s
address |
3703 DOTY ROAD, SUITE 7, WOODSTOCK, IL, 60098
|
Plan administrator’s name and address
Administrator’s EIN |
300202393 |
Plan administrator’s name |
TOWN SQUARE ANESTHESIA, LLC |
Plan administrator’s
address |
3703 DOTY ROAD, SUITE 7, WOODSTOCK, IL, 60098 |
Administrator’s telephone number |
8153343170 |
Signature of
Role |
Plan administrator |
Date |
2012-10-11 |
Name of individual signing |
WILLIAM WEEMS |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2012-10-11 |
Name of individual signing |
WILLIAM WEEMS |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
TOWN SQUARE ANESTHESIA, LLC PROFIT SHARING PLAN & TRUST
|
2011
|
300202393
|
2012-10-11
|
TOWN SQUARE ANESTHESIA, LLC
|
8
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2004-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8153343170
|
Plan sponsor’s
address |
3703 DOTY ROAD, SUITE 7, WOODSTOCK, IL, 60098
|
Plan administrator’s name and address
Administrator’s EIN |
300202393 |
Plan administrator’s name |
TOWN SQUARE ANESTHESIA, LLC |
Plan administrator’s
address |
3703 DOTY ROAD, SUITE 7, WOODSTOCK, IL, 60098 |
Administrator’s telephone number |
8153343170 |
Signature of
Role |
Plan administrator |
Date |
2012-10-11 |
Name of individual signing |
WILLIAM WEEMS |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2012-10-11 |
Name of individual signing |
WILLIAM WEEMS |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
TOWN SQUARE ANESTHESIA, LLC PROFIT SHARING PLAN & TRUST
|
2010
|
300202393
|
2011-09-26
|
TOWN SQUARE ANESTHESIA, LLC
|
7
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2004-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8153343170
|
Plan sponsor’s
address |
3703 DOTY ROAD, SUITE 7, WOODSTOCK, IL, 60098
|
Plan administrator’s name and address
Administrator’s EIN |
300202393 |
Plan administrator’s name |
TOWN SQUARE ANESTHESIA, LLC |
Plan administrator’s
address |
3703 DOTY ROAD, SUITE 7, WOODSTOCK, IL, 60098 |
Administrator’s telephone number |
8153343170 |
Signature of
Role |
Plan administrator |
Date |
2011-09-26 |
Name of individual signing |
WILLIAM WEEMS |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2011-09-26 |
Name of individual signing |
WILLIAM WEEMS |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
TOWN SQUARE ANESTHESIA, LLC CASH BALANCE PENSION PLAN & TRUST
|
2010
|
300202393
|
2011-09-26
|
TOWN SQUARE ANESTHESIA, LLC
|
4
|
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
2010-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8153343170
|
Plan sponsor’s
address |
3703 DOTY ROAD, SUITE 7, WOODSTOCK, IL, 60098
|
Plan administrator’s name and address
Administrator’s EIN |
300202393 |
Plan administrator’s name |
TOWN SQUARE ANESTHESIA, LLC |
Plan administrator’s
address |
3703 DOTY ROAD, SUITE 7, WOODSTOCK, IL, 60098 |
Administrator’s telephone number |
8153343170 |
Signature of
Role |
Plan administrator |
Date |
2011-09-23 |
Name of individual signing |
WILLIAM WEEMS |
Valid signature |
Filed with incorrect/unrecognized electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2011-09-23 |
Name of individual signing |
WILLIAM WEEMS |
Valid signature |
Filed with incorrect/unrecognized electronic signature |
|
|
TOWN SQUARE ANESTHESIA, LLC PROFIT SHARING PLAN & TRUST
|
2010
|
300202393
|
2011-09-26
|
TOWN SQUARE ANESTHESIA, LLC
|
7
|
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2004-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8153343170
|
Plan sponsor’s
address |
3703 DOTY ROAD, SUITE 7, WOODSTOCK, IL, 60098
|
Plan administrator’s name and address
Administrator’s EIN |
300202393 |
Plan administrator’s name |
TOWN SQUARE ANESTHESIA, LLC |
Plan administrator’s
address |
3703 DOTY ROAD, SUITE 7, WOODSTOCK, IL, 60098 |
Administrator’s telephone number |
8153343170 |
Signature of
Role |
Plan administrator |
Date |
2011-09-23 |
Name of individual signing |
WILLIAM WEEMS |
Valid signature |
Filed with incorrect/unrecognized electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2011-09-23 |
Name of individual signing |
WILLIAM WEEMS |
Valid signature |
Filed with incorrect/unrecognized electronic signature |
|
|
TOWN SQUARE ANESTHESIA, LLC CASH BALANCE PENSION PLAN & TRUST
|
2010
|
300202393
|
2011-09-26
|
TOWN SQUARE ANESTHESIA, LLC
|
4
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
2010-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8153343170
|
Plan sponsor’s
address |
3703 DOTY ROAD, SUITE 7, WOODSTOCK, IL, 60098
|
Plan administrator’s name and address
Administrator’s EIN |
300202393 |
Plan administrator’s name |
TOWN SQUARE ANESTHESIA, LLC |
Plan administrator’s
address |
3703 DOTY ROAD, SUITE 7, WOODSTOCK, IL, 60098 |
Administrator’s telephone number |
8153343170 |
Signature of
Role |
Plan administrator |
Date |
2011-09-26 |
Name of individual signing |
WILLIAM WEEMS |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2011-09-26 |
Name of individual signing |
WILLIAM WEEMS |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
TOWN SQUARE ANESTHESIA, LLC PROFIT SHARING PLAN & TRUST
|
2009
|
300202393
|
2010-07-12
|
TOWN SQUARE ANESTHESIA, LLC
|
7
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2004-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8153343170
|
Plan sponsor’s
address |
3703 DOTY ROAD, SUITE 7, WOODSTOCK, IL, 60098
|
Plan administrator’s name and address
Administrator’s EIN |
300202393 |
Plan administrator’s name |
TOWN SQUARE ANESTHESIA, LLC |
Plan administrator’s
address |
3703 DOTY ROAD, SUITE 7, WOODSTOCK, IL, 60098 |
Administrator’s telephone number |
8153343170 |
Signature of
Role |
Plan administrator |
Date |
2010-07-12 |
Name of individual signing |
WILLIAM WEEMS |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2010-07-12 |
Name of individual signing |
WILLIAM WEEMS |
Valid signature |
Filed with authorized/valid electronic signature |
|
|