| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2010-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
6308525353
|
| Plan sponsor’s
address |
6317 FAIRVIEW AVE., WESTMONT, IL, 60559
|
Plan administrator’s name and address
| Administrator’s EIN |
363607708 |
| Plan administrator’s name |
FAIRVIEW DENTAL CARE |
| Plan administrator’s
address |
6317 FAIRVIEW AVE., WESTMONT, IL, 60559 |
| Administrator’s telephone number |
6308525353 |
Signature of
| Role |
Plan administrator |
| Date |
2011-06-14 |
| Name of individual signing |
DARREN DWAIN SIMPSON |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2011-06-14 |
| Name of individual signing |
DARREN DWAIN SIMPSON |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
