File |
View Page
|
Three-digit plan number (PN) |
005
|
Effective date of plan |
2009-01-01
|
Business code |
621399
|
Sponsor’s telephone number |
8473810106
|
Plan sponsor’s
address |
303 N. NORTHWEST HIGHWAY, BARRINGTON, IL, 60010
|
Plan administrator’s name and address
Administrator’s EIN |
362946173 |
Plan administrator’s name |
ORAL FACIAL AND IMPLANT SPECIALISTS, P.C |
Plan administrator’s
address |
303 N. NORTHWEST HIGHWAY, BARRINGTON, IL, 60010 |
Administrator’s telephone number |
8473810106 |
Signature of
Role |
Plan administrator |
Date |
2010-10-07 |
Name of individual signing |
MARTIN ZIDRON |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2010-10-07 |
Name of individual signing |
MARTIN ZIDRON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|