KOZIOL-THOMS EYE ASSOCIATES, S.C. RETIREMENT PLAN & TRUST
|
2011
|
363338174
|
2013-07-03
|
KOZIOL-THOMS EYE ASSOCIATES, S.C.
|
24
|
|
File |
View Page
|
Three-digit plan number (PN) |
003
|
Effective date of plan |
2002-12-01
|
Business code |
621111
|
Sponsor’s telephone number |
8472592777
|
Plan sponsor’s
address |
1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142
|
Plan administrator’s name and address
Administrator’s EIN |
363338174 |
Plan administrator’s name |
KOZIOL-THOMS EYE ASSOCIATES, S.C. |
Plan administrator’s
address |
1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142 |
Administrator’s telephone number |
8472592777 |
Signature of
Role |
Plan administrator |
Date |
2013-07-03 |
Name of individual signing |
JEFFREY E. KOZIOL, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
KOZIOL-THOMS EYE ASSOCIATES, S.C., CASH OR DEFERRED PROFIT SHARING PLAN & TRUST
|
2011
|
363338174
|
2013-07-03
|
KOZIOL-THOMS EYE ASSOCIATES, S.C.
|
26
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
1987-12-01
|
Business code |
621111
|
Sponsor’s telephone number |
8472592777
|
Plan sponsor’s
address |
1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142
|
Plan administrator’s name and address
Administrator’s EIN |
363338174 |
Plan administrator’s name |
KOZIOL-THOMS EYE ASSOCIATES, S.C. |
Plan administrator’s
address |
1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142 |
Administrator’s telephone number |
8472592777 |
Signature of
Role |
Plan administrator |
Date |
2013-07-03 |
Name of individual signing |
JEFFREY E. KOZIOL, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
KOZIOL-THOMS EYE ASSOCIATES, S.C. RETIREMENT PLAN & TRUST
|
2010
|
363338174
|
2012-09-04
|
KOZIOL-THOMS EYE ASSOCIATES, S.C.
|
26
|
|
File |
View Page
|
Three-digit plan number (PN) |
003
|
Effective date of plan |
2002-12-01
|
Business code |
621111
|
Sponsor’s telephone number |
8472592777
|
Plan sponsor’s
address |
1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142
|
Plan administrator’s name and address
Administrator’s EIN |
363338174 |
Plan administrator’s name |
KOZIOL-THOMS EYE ASSOCIATES, S.C. |
Plan administrator’s
address |
1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142 |
Administrator’s telephone number |
8472592777 |
Signature of
Role |
Plan administrator |
Date |
2012-09-04 |
Name of individual signing |
JEFFREY E. KOZIOL, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
KOZIOL-THOMS EYE ASSOCIATES, S.C., CASH OR DEFERRED PROFIT SHARING PLAN & TRUST
|
2010
|
363338174
|
2012-09-04
|
KOZIOL-THOMS EYE ASSOCIATES, S.C.
|
28
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
1987-12-01
|
Business code |
621111
|
Sponsor’s telephone number |
8472592777
|
Plan sponsor’s
address |
1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142
|
Plan administrator’s name and address
Administrator’s EIN |
363338174 |
Plan administrator’s name |
KOZIOL-THOMS EYE ASSOCIATES, S.C. |
Plan administrator’s
address |
1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142 |
Administrator’s telephone number |
8472592777 |
Signature of
Role |
Plan administrator |
Date |
2012-09-04 |
Name of individual signing |
JEFFREY E. KOZIOL, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
KOZIOL-THOMS EYE ASSOCIATES, S.C. RETIREMENT PLAN & TRUST
|
2009
|
363338174
|
2011-09-06
|
KOZIOL-THOMS EYE ASSOCIATES, S.C.
|
28
|
|
File |
View Page
|
Three-digit plan number (PN) |
003
|
Effective date of plan |
2002-12-01
|
Business code |
621111
|
Sponsor’s telephone number |
8472592777
|
Plan sponsor’s
address |
1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142
|
Plan administrator’s name and address
Administrator’s EIN |
363338174 |
Plan administrator’s name |
KOZIOL-THOMS EYE ASSOCIATES, S.C. |
Plan administrator’s
address |
1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142 |
Administrator’s telephone number |
8472592777 |
Signature of
Role |
Plan administrator |
Date |
2011-09-06 |
Name of individual signing |
JEFFREY E. KOZIOL, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
KOZIOL-THOMS EYE ASSOCIATES, S.C., CASH OR DEFERRED PROFIT SHARING PLAN & TRUST
|
2009
|
363338174
|
2011-09-06
|
KOZIOL-THOMS EYE ASSOCIATES, S.C.
|
28
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
1987-12-01
|
Business code |
621111
|
Sponsor’s telephone number |
8472592777
|
Plan sponsor’s
address |
1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142
|
Plan administrator’s name and address
Administrator’s EIN |
363338174 |
Plan administrator’s name |
KOZIOL-THOMS EYE ASSOCIATES, S.C. |
Plan administrator’s
address |
1211 S ARLINGTON HEIGHTS RD, ARLINGTON HEIGHTS, IL, 600053142 |
Administrator’s telephone number |
8472592777 |
Signature of
Role |
Plan administrator |
Date |
2011-09-06 |
Name of individual signing |
JEFFREY E. KOZIOL, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|