FOUR FORTY FORUM, LTD.

Company Details

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

LIEBERMAN EYE ASSOCIATES, LTD. 401(K) PROFIT SHARING PLAN

2010

363744019

2011-08-23

LIEBERMAN EYE ASSOCIATES, LTD.

Plan administrator’s name and address

Administrator’s EIN	363744019
Plan administrator’s name	LIEBERMAN EYE ASSOCIATES, LTD.
Plan administrator’s address	5600 WEST ADDISON ST., CHICAGO, IL, 60634
Administrator’s telephone number	7737361717

Signature of

Role	Plan administrator
Date	2011-08-23
Name of individual signing	MARK BURANOSKY
Valid signature	Filed with authorized/valid electronic signature

LIEBERMAN EYE ASSOCIATES, LTD. 401(K) PROFIT SHARING PLAN

2009

363744019

2010-09-22

LIEBERMAN EYE ASSOCIATES, LTD.

Plan administrator’s name and address

Administrator’s EIN	363744019
Plan administrator’s name	LIEBERMAN EYE ASSOCIATES, LTD.
Plan administrator’s address	5600 WEST ADDISON ST., CHICAGO, IL, 60634
Administrator’s telephone number	7737361717

Signature of

Role	Plan administrator
Date	2010-09-22
Name of individual signing	MARK BURANOSKY
Valid signature	Filed with authorized/valid electronic signature

Name and Address	Role	Appointment Date
WILLIAM O MORRISON JR, 440 S 3RD ST STE 202, ST CHARLES, 60174, KANE	Agent	2013-05-24

Name and Address	Role
AS ABOVE	Secretary

Name and Address	Role
WILLIAM O MORRISON JR, 1081 DANFORTH DR BATAVIA IL 60510	President

Class	Series	Voting Rights	Authorized Shares	Issued Shares	Par Value
COMM	No data	Voting Rights	10000	1000000	No data

Date of last update: 16 Jan 2025