ROBERT KAGAN, M.D., S.C. PROFIT SHARING PLAN AND TRUST
|
2012
|
363930274
|
2013-10-08
|
ROBERT KAGAN, M.D., S.C.
|
6
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1994-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8479529333
|
Plan sponsor’s
address |
810 BIESTERFIELD ROAD, SUITE 302, ELK GROVE VILLAGE, IL, 60007
|
Signature of
Role |
Plan administrator |
Date |
2013-10-08 |
Name of individual signing |
EDWARD TILLERY |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
ROBERT KAGAN, M.D., S.C. CASH BALANCE PENSION PLAN
|
2011
|
363930274
|
2012-10-03
|
ROBERT KAGAN, M.D., S.C.
|
4
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
2008-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8479529333
|
Plan sponsor’s
address |
810 BIESTERFIELD ROAD, SUITE 302, ELK GROVE VILLAGE, IL, 60007
|
Plan administrator’s name and address
Administrator’s EIN |
363930274 |
Plan administrator’s name |
ROBERT KAGAN, M.D., S.C. |
Plan administrator’s
address |
810 BIESTERFIELD ROAD, SUITE 302, ELK GROVE VILLAGE, IL, 60007 |
Administrator’s telephone number |
8479529333 |
Signature of
Role |
Plan administrator |
Date |
2012-10-03 |
Name of individual signing |
ROBERT KAGAN, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
ROBERT KAGAN, M.D., S.C. PROFIT SHARING PLAN AND TRUST
|
2011
|
363930274
|
2012-08-22
|
ROBERT KAGAN, M.D., S.C.
|
6
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1994-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8479529333
|
Plan sponsor’s
address |
810 BIESTERFIELD ROAD, SUITE 302, ELK GROVE VILLAGE, IL, 60007
|
Plan administrator’s name and address
Administrator’s EIN |
363930274 |
Plan administrator’s name |
ROBERT KAGAN, M.D., S.C. |
Plan administrator’s
address |
810 BIESTERFIELD ROAD, SUITE 302, ELK GROVE VILLAGE, IL, 60007 |
Administrator’s telephone number |
8479529333 |
Signature of
Role |
Plan administrator |
Date |
2012-08-22 |
Name of individual signing |
ROBERT S. KAGAN, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
ROBERT KAGAN, M.D., S.C. CASH BALANCE PENSION PLAN
|
2010
|
363930274
|
2011-10-04
|
ROBERT KAGAN, M.D., S.C.
|
3
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
2008-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8479529333
|
Plan sponsor’s
address |
810 BIESTERFIELD ROAD, SUITE 302, ELK GROVE VILLAGE, IL, 60007
|
Plan administrator’s name and address
Administrator’s EIN |
363930274 |
Plan administrator’s name |
ROBERT KAGAN, M.D., S.C. |
Plan administrator’s
address |
810 BIESTERFIELD ROAD, SUITE 302, ELK GROVE VILLAGE, IL, 60007 |
Administrator’s telephone number |
8479529333 |
Signature of
Role |
Plan administrator |
Date |
2011-10-04 |
Name of individual signing |
ROBERT KAGAN, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
ROBERT KAGAN, M.D., S.C. PROFIT SHARING PLAN AND TRUST
|
2010
|
363930274
|
2011-09-02
|
ROBERT KAGAN, M.D., S.C.
|
5
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1994-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8479529333
|
Plan sponsor’s
address |
810 BIESTERFIELD ROAD, SUITE 302, ELK GROVE VILLAGE, IL, 60007
|
Plan administrator’s name and address
Administrator’s EIN |
363930274 |
Plan administrator’s name |
ROBERT KAGAN, M.D., S.C. |
Plan administrator’s
address |
810 BIESTERFIELD ROAD, SUITE 302, ELK GROVE VILLAGE, IL, 60007 |
Administrator’s telephone number |
8479529333 |
Signature of
Role |
Plan administrator |
Date |
2011-09-02 |
Name of individual signing |
ROBERT S. KAGAN, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2011-09-02 |
Name of individual signing |
ROBERT S. KAGAN, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
ROBERT KAGAN, M.D., S.C. PROFIT SHARING PLAN AND TRUST
|
2009
|
363930274
|
2010-11-08
|
ROBERT KAGAN, M.D., S.C.
|
6
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1994-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8479529333
|
Plan sponsor’s
address |
810 BIESTERFIELD ROAD, SUITE 302, ELK GROVE VILLAGE, IL, 60007
|
Plan administrator’s name and address
Administrator’s EIN |
363930274 |
Plan administrator’s name |
ROBERT KAGAN, M.D., S.C. |
Plan administrator’s
address |
810 BIESTERFIELD ROAD, SUITE 302, ELK GROVE VILLAGE, IL, 60007 |
Administrator’s telephone number |
8479529333 |
Signature of
Role |
Plan administrator |
Date |
2010-11-08 |
Name of individual signing |
ROBERT S. KAGAN, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
ROBERT KAGAN, M.D., S.C. CASH BALANCE PENSION PLAN
|
2009
|
363930274
|
2010-12-13
|
ROBERT KAGAN, M.D., S.C.
|
4
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
2008-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8479529333
|
Plan sponsor’s
address |
810 BIESTERFIELD ROAD, SUITE 302, ELK GROVE VILLAGE, IL, 60007
|
Plan administrator’s name and address
Administrator’s EIN |
363930274 |
Plan administrator’s name |
ROBERT KAGAN, M.D., S.C. |
Plan administrator’s
address |
810 BIESTERFIELD ROAD, SUITE 302, ELK GROVE VILLAGE, IL, 60007 |
Administrator’s telephone number |
8479529333 |
Signature of
Role |
Plan administrator |
Date |
2010-12-13 |
Name of individual signing |
ROBERT KAGAN, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
ROBERT KAGAN, M.D., S.C. CASH BALANCE PENSION PLAN
|
2009
|
363930274
|
2010-10-05
|
ROBERT KAGAN, M.D., S.C.
|
4
|
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
2008-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8479529333
|
Plan sponsor’s
address |
810 BIESTERFIELD ROAD, SUITE 302, ELK GROVE VILLAGE, IL, 60007
|
Plan administrator’s name and address
Administrator’s EIN |
363930274 |
Plan administrator’s name |
ROBERT KAGAN, M.D., S.C. |
Plan administrator’s
address |
810 BIESTERFIELD ROAD, SUITE 302, ELK GROVE VILLAGE, IL, 60007 |
Administrator’s telephone number |
8479529333 |
Signature of
Role |
Plan administrator |
Date |
2010-10-05 |
Name of individual signing |
ROBERT KAGAN, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
ROBERT KAGAN, M.D., S.C. PROFIT SHARING PLAN AND TRUST
|
2009
|
363930274
|
2010-10-05
|
ROBERT KAGAN, M.D., S.C.
|
6
|
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1994-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8479529333
|
Plan sponsor’s
address |
810 BIESTERFIELD ROAD, SUITE 302, ELK GROVE VILLAGE, IL, 60007
|
Plan administrator’s name and address
Administrator’s EIN |
363930274 |
Plan administrator’s name |
ROBERT KAGAN, M.D., S.C. |
Plan administrator’s
address |
810 BIESTERFIELD ROAD, SUITE 302, ELK GROVE VILLAGE, IL, 60007 |
Administrator’s telephone number |
8479529333 |
Signature of
Role |
Plan administrator |
Date |
2010-10-05 |
Name of individual signing |
ROBERT S. KAGAN, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|