H. GORDON DAVIS, III, M.D., S.C. 401(K) PROFIT SHARING PLAN
|
2011
|
363519395
|
2012-10-02
|
H. GORDON DAVIS, III, M.D., S.C.
|
5
|
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1989-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8478840906
|
Plan sponsor’s
address |
2500 W. HIGGINS ROAD SUITE 640, HOFFMAN ESTATES, IL, 60195
|
Plan administrator’s name and address
Administrator’s EIN |
363519395 |
Plan administrator’s name |
H. GORDON DAVIS, III, M.D., S.C. |
Plan administrator’s
address |
2500 W. HIGGINS ROAD SUITE 640, HOFFMAN ESTATES, IL, 60195 |
Administrator’s telephone number |
8478840906 |
Signature of
Role |
Plan administrator |
Date |
2012-10-01 |
Name of individual signing |
ANNE DAVIS |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2012-10-01 |
Name of individual signing |
ANNE DAVIS |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
H. GORDON DAVIS, III, M.D., S.C. 401(K) PROFIT SHARING PLAN
|
2011
|
363519395
|
2013-08-22
|
H. GORDON DAVIS, III, M.D., S.C.
|
4
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1989-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8478840906
|
Plan sponsor’s
address |
2500 W. HIGGINS ROAD SUITE 640, HOFFMAN ESTATES, IL, 60195
|
Plan administrator’s name and address
Administrator’s EIN |
363519395 |
Plan administrator’s name |
H. GORDON DAVIS, III, M.D., S.C. |
Plan administrator’s
address |
2500 W. HIGGINS ROAD SUITE 640, HOFFMAN ESTATES, IL, 60195 |
Administrator’s telephone number |
8478840906 |
Signature of
Role |
Plan administrator |
Date |
2013-08-22 |
Name of individual signing |
H. GORDON DAVIS |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-08-22 |
Name of individual signing |
H. GORDON DAVIS |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
H. GORDON DAVIS, III, M.D., S.C. 401(K) PROFIT SHARING PLAN
|
2010
|
363519395
|
2011-10-13
|
H. GORDON DAVIS, III, M.D., S.C.
|
5
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1989-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8478840906
|
Plan sponsor’s
address |
2500 W. HIGGINS ROAD SUITE 640, HOFFMAN ESTATES, IL, 60195
|
Plan administrator’s name and address
Administrator’s EIN |
363519395 |
Plan administrator’s name |
H. GORDON DAVIS, III, M.D., S.C. |
Plan administrator’s
address |
2500 W. HIGGINS ROAD SUITE 640, HOFFMAN ESTATES, IL, 60195 |
Administrator’s telephone number |
8478840906 |
Signature of
Role |
Plan administrator |
Date |
2011-10-13 |
Name of individual signing |
H. GORDON DAVIS, III M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2011-10-13 |
Name of individual signing |
H. GORDON DAVIS, III M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
H. GORDON DAVIS, III, M.D., S.C. 401(K) PROFIT SHARING PLAN
|
2009
|
363519395
|
2010-09-28
|
H. GORDON DAVIS, III, M.D., S.C.
|
6
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1989-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8478840906
|
Plan sponsor’s
address |
2500 W. HIGGINS ROAD SUITE 640, HOFFMAN ESTATES, IL, 60195
|
Plan administrator’s name and address
Administrator’s EIN |
363519395 |
Plan administrator’s name |
H. GORDON DAVIS, III, M.D., S.C. |
Plan administrator’s
address |
2500 W. HIGGINS ROAD SUITE 640, HOFFMAN ESTATES, IL, 60195 |
Administrator’s telephone number |
8478840906 |
Signature of
Role |
Plan administrator |
Date |
2010-09-28 |
Name of individual signing |
H. GORDON DAVIS, III, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2010-09-28 |
Name of individual signing |
H. GORDON DAVIS, III, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|