KIRK PAVLETIC 401(K) PLAN
|
2011
|
363824109
|
2012-07-20
|
KIRK P. PAVLETIC O.D. P.C.
|
4
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2009-01-01
|
Business code |
621320
|
Sponsor’s telephone number |
7084037711
|
Plan sponsor’s
address |
10739 WEST 159TH STREET, ORLAND PARK, IL, 60467
|
Plan administrator’s name and address
Administrator’s EIN |
363824109 |
Plan administrator’s name |
KIRK P. PAVLETIC O.D. P.C. |
Plan administrator’s
address |
10739 WEST 159TH STREET, ORLAND PARK, IL, 60467 |
Administrator’s telephone number |
7084037711 |
Signature of
Role |
Plan administrator |
Date |
2012-07-20 |
Name of individual signing |
KIRK PAVLETIC |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2012-07-20 |
Name of individual signing |
KIRK PAVLETIC |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
KIRK PAVLETIC 401(K) PLAN
|
2010
|
363824109
|
2011-06-23
|
KIRK P. PAVLETIC O.D. P.C.
|
4
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2009-01-01
|
Business code |
621320
|
Sponsor’s telephone number |
7084037711
|
Plan sponsor’s
address |
10739 WEST 159TH STREET, ORLAND PARK, IL, 60467
|
Plan administrator’s name and address
Administrator’s EIN |
363824109 |
Plan administrator’s name |
KIRK P. PAVLETIC O.D. P.C. |
Plan administrator’s
address |
10739 WEST 159TH STREET, ORLAND PARK, IL, 60467 |
Administrator’s telephone number |
7084037711 |
Signature of
Role |
Plan administrator |
Date |
2011-06-23 |
Name of individual signing |
KIRK PAVLETIC |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2011-06-23 |
Name of individual signing |
KIRK PAVLETIC |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
KIRK PAVLETIC 401(K) PLAN
|
2009
|
363824109
|
2010-07-21
|
KIRK P. PAVLETIC O.D. P.C.
|
0
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2009-01-01
|
Business code |
621320
|
Sponsor’s telephone number |
7084037711
|
Plan sponsor’s
address |
10739 WEST 159TH STREET, ORLAND PARK, IL, 60467
|
Plan administrator’s name and address
Administrator’s EIN |
363824109 |
Plan administrator’s name |
KIRK P. PAVLETIC O.D. P.C. |
Plan administrator’s
address |
10739 WEST 159TH STREET, ORLAND PARK, IL, 60467 |
Administrator’s telephone number |
7084037711 |
Signature of
Role |
Plan administrator |
Date |
2010-07-21 |
Name of individual signing |
KIRK PAVLETIC |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2010-07-21 |
Name of individual signing |
KIRK PAVLETIC |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
KIRK PAVLETIC 401(K) PLAN
|
2009
|
363824109
|
2010-07-21
|
KIRK P. PAVLETIC O.D. P.C.
|
0
|
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2009-01-01
|
Business code |
621320
|
Sponsor’s telephone number |
7084037711
|
Plan sponsor’s
address |
10739 WEST 159TH STREET, ORLAND PARK, IL, 60467
|
Plan administrator’s name and address
Administrator’s EIN |
363824109 |
Plan administrator’s name |
KIRK P. PAVLETIC O.D. P.C. |
Plan administrator’s
address |
10739 WEST 159TH STREET, ORLAND PARK, IL, 60467 |
Administrator’s telephone number |
7084037711 |
Signature of
Role |
Plan administrator |
Date |
2010-07-21 |
Name of individual signing |
KIRK PAVLETIC |
Valid signature |
Filed with incorrect/unrecognized electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2010-07-21 |
Name of individual signing |
KIRK PAVLETIC |
Valid signature |
Filed with incorrect/unrecognized electronic signature |
|
|
KIRK PAVLETIC 401(K) PLAN
|
2009
|
363824109
|
2010-07-21
|
KIRK P. PAVLETIC O.D. P.C.
|
0
|
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2009-01-01
|
Business code |
621320
|
Sponsor’s telephone number |
7084037711
|
Plan sponsor’s
address |
10739 WEST 159TH STREET, ORLAND PARK, IL, 60467
|
Plan administrator’s name and address
Administrator’s EIN |
363824109 |
Plan administrator’s name |
KIRK P. PAVLETIC O.D. P.C. |
Plan administrator’s
address |
10739 WEST 159TH STREET, ORLAND PARK, IL, 60467 |
Administrator’s telephone number |
7084037711 |
Signature of
Role |
Plan administrator |
Date |
2010-07-21 |
Name of individual signing |
KIRK PAVLETIC |
Valid signature |
Filed with incorrect/unrecognized electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2010-07-21 |
Name of individual signing |
KIRK PAVLETIC |
Valid signature |
Filed with incorrect/unrecognized electronic signature |
|
|