VIJAY M. HARYANI, M.D., S.C. RETIREMENT PLAN AND TRUST
|
2015
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364113871
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2016-04-22
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VIJAY M. HARYANI, M.D., S.C.
|
20
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|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
2005-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8159363240
|
Plan sponsor’s
address |
3627 TOULOUSE, BOURBONNAIS, IL, 609144552
|
|
VIJAY M. HARYANI, M.D., S.C. RETIREMENT PLAN AND TRUST
|
2014
|
364113871
|
2015-09-15
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VIJAY M. HARYANI, M.D., S.C.
|
23
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
2005-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8159363240
|
Plan sponsor’s
address |
3627 TOULOUSE, BOURBONNAIS, IL, 609144552
|
Signature of
Role |
Plan administrator |
Date |
2015-09-15 |
Name of individual signing |
VIJAY M. HARYANI, M.D., PRESIDENT |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
VIJAY M. HARYANI, M.D., S.C. CASH OR DEFERRED PROFIT-SHARING PLAN & TRUST
|
2014
|
364113871
|
2015-10-15
|
VIJAY M. HARYANI, M.D., S.C.
|
17
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2005-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8159363240
|
Plan sponsor’s
address |
3627 TOULOUSE STREET, BOURBONNAIS, IL, 60914
|
Signature of
Role |
Plan administrator |
Date |
2015-10-15 |
Name of individual signing |
VIJAY HARYANI |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
VIJAY M. HARYANI, M.D., S.C. CASH OR DEFERRED PROFIT-SHARING PLAN & TRUST
|
2014
|
364113871
|
2015-04-10
|
VIJAY M. HARYANI, M.D., S.C.
|
23
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2005-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8159363240
|
Plan sponsor’s
address |
3627 TOULOUSE STREET, BOURBONNAIS, IL, 60914
|
Signature of
Role |
Plan administrator |
Date |
2015-04-09 |
Name of individual signing |
VIJAY HARYANI |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
VIJAY M. HARYANI, M.D., S.C. RETIREMENT PLAN AND TRUST
|
2013
|
364113871
|
2014-07-07
|
VIJAY M. HARYANI, M.D., S.C.
|
18
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
2005-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8159363240
|
Plan sponsor’s
address |
3627 TOULOUSE, BOURBONNAIS, IL, 609144552
|
Signature of
Role |
Plan administrator |
Date |
2014-07-07 |
Name of individual signing |
VIJAY M. HARYANI, M.D., PRESIDENT |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
VIJAY M. HARYANI, M.D., S.C. CASH OR DEFERRED PROFIT-SHARING PLAN & TRUST
|
2013
|
364113871
|
2014-05-06
|
VIJAY M. HARYANI, M.D., S.C.
|
19
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2005-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8159363240
|
Plan sponsor’s
address |
3627 TOULOUSE STREET, BOURBONNAIS, IL, 60914
|
Signature of
Role |
Plan administrator |
Date |
2014-05-06 |
Name of individual signing |
VIJAY HARYANI |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
VIJAY M. HARYANI, M.D., S.C. RETIREMENT PLAN AND TRUST
|
2012
|
364113871
|
2013-09-05
|
VIJAY M. HARYANI, M.D., S.C.
|
16
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
2005-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8159363240
|
Plan sponsor’s
address |
3627 TOULOUSE, BOURBONNAIS, IL, 609144552
|
Signature of
Role |
Plan administrator |
Date |
2013-09-05 |
Name of individual signing |
VIJAY M. HARYANI, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
VIJAY M. HARYANI, M.D., S.C. CASH OR DEFERRED PROFIT-SHARING PLAN & TRUST
|
2012
|
364113871
|
2013-06-17
|
VIJAY M. HARYANI, M.D., S.C.
|
18
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2005-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8159363240
|
Plan sponsor’s
address |
375 N. WALL STREET, STE 310, KANKAKEE, IL, 60901
|
Signature of
Role |
Plan administrator |
Date |
2013-06-17 |
Name of individual signing |
VIJAY HARYANI |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
VIJAY M. HARYANI, M.D., S.C. CASH OR DEFERRED PROFIT-SHARING PLAN & TRUST
|
2011
|
364113871
|
2012-08-09
|
VIJAY M. HARYANI, M.D., S.C.
|
17
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2005-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8159363240
|
Plan sponsor’s
address |
375 N. WALL STREET, STE 310, KANKAKEE, IL, 60901
|
Plan administrator’s name and address
Administrator’s EIN |
364113871 |
Plan administrator’s name |
VIJAY M. HARYANI, M.D., S.C. |
Plan administrator’s
address |
375 N. WALL STREET, STE 310, KANKAKEE, IL, 60901 |
Administrator’s telephone number |
8159363240 |
Signature of
Role |
Plan administrator |
Date |
2012-08-08 |
Name of individual signing |
VIJAY HARYANI |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
VIJAY M. HARYANI, M.D., S.C. RETIREMENT PLAN AND TRUST
|
2011
|
364113871
|
2012-04-11
|
VIJAY M. HARYANI, M.D., S.C.
|
17
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
2005-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8159363240
|
Plan sponsor’s
address |
3627 TOULOUSE, BOURBONNAIS, IL, 609144552
|
Plan administrator’s name and address
Administrator’s EIN |
364113871 |
Plan administrator’s name |
VIJAY M. HARYANI, M.D., S.C. |
Plan administrator’s
address |
3627 TOULOUSE, BOURBONNAIS, IL, 609144552 |
Administrator’s telephone number |
8159363240 |
Signature of
Role |
Plan administrator |
Date |
2012-04-11 |
Name of individual signing |
VIJAY M. HARYANI, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|