MICHAEL E. LONGEVIN M.D., S.C. PROFIT SHARING PLAN
|
2011
|
371200311
|
2012-07-20
|
MICHAEL E. LONGEVIN M.D., S.C.
|
3
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1992-09-21
|
Business code |
621111
|
Sponsor’s telephone number |
3096925828
|
Plan sponsor’s
address |
5401 N. KNOXVILLE, STE. 112, PEORIA, IL, 61614
|
Plan administrator’s name and address
Administrator’s EIN |
371200311 |
Plan administrator’s name |
MICHAEL E. LONGEVIN M.D., S.C. |
Plan administrator’s
address |
5401 N. KNOXVILLE STE. 112, PEORIA, IL, 61614 |
Administrator’s telephone number |
3096925828 |
Signature of
Role |
Plan administrator |
Date |
2012-07-20 |
Name of individual signing |
DR. MICHAEL E. LONGEVIN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
MICHAEL E. LONGEVIN M.D., S.C. PROFIT SHARING PLAN
|
2010
|
371200311
|
2011-04-11
|
MICHAEL E. LONGEVIN M.D., S.C.
|
3
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1992-09-21
|
Business code |
621111
|
Sponsor’s telephone number |
3096925828
|
Plan sponsor’s
address |
5401 N. KNOXVILLE, PEORIA, IL, 61614
|
Plan administrator’s name and address
Administrator’s EIN |
371200311 |
Plan administrator’s name |
MICHAEL E. LONGEVIN M.D., S.C. |
Plan administrator’s
address |
5401 N. KNOXVILLE, PEORIA, IL, 61614 |
Administrator’s telephone number |
3096925828 |
Signature of
Role |
Plan administrator |
Date |
2011-04-11 |
Name of individual signing |
MICHAEL E. LONGEVIN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2011-04-11 |
Name of individual signing |
MICHAEL E. LONGEVIN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
MICHAEL E. LONGEVIN M.D., S.C. PROFIT SHARING PLAN
|
2009
|
371200311
|
2010-07-21
|
MICHAEL E. LONGEVIN M.D., S.C.
|
3
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1992-09-21
|
Business code |
621111
|
Sponsor’s telephone number |
3096925828
|
Plan sponsor’s
address |
5401 N. KNOXVILLE, PEORIA, IL, 61614
|
Plan administrator’s name and address
Administrator’s EIN |
371200311 |
Plan administrator’s name |
MICHAEL E. LONGEVIN M.D., S.C. |
Plan administrator’s
address |
5401 N. KNOXVILLE, PEORIA, IL, 61614 |
Administrator’s telephone number |
3096925828 |
Signature of
Role |
Plan administrator |
Date |
2010-07-21 |
Name of individual signing |
MICHAEL LONGEVIN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2010-07-21 |
Name of individual signing |
MICHAEL LONGEVIN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|