FOX RIVER PERIODONTICS, P.C. 401(K) PROFIT SHARING PLAN
|
2011
|
363928372
|
2012-07-26
|
FOX RIVER PERIODONTICS, P.C.
|
10
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2006-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
6302327400
|
Plan sponsor’s
address |
2075 BLACKBERRY DRIVE, GENEVA, IL, 60134
|
Plan administrator’s name and address
Administrator’s EIN |
363928372 |
Plan administrator’s name |
FOX RIVER PERIODONTICS, P.C. |
Plan administrator’s
address |
2075 BLACKBERRY DRIVE, GENEVA, IL, 60134 |
Administrator’s telephone number |
6302327400 |
Signature of
Role |
Plan administrator |
Date |
2012-07-26 |
Name of individual signing |
KAMBIZ NORUZI |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
FOX RIVER PERIODONTICS, P.C. 401(K) PROFIT SHARING PLAN
|
2010
|
363928372
|
2011-07-27
|
FOX RIVER PERIODONTICS, P.C.
|
13
|
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2006-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
6302327400
|
Plan sponsor’s
address |
2075 BLACKBERRY DRIVE, GENEVA, IL, 60134
|
Plan administrator’s name and address
Administrator’s EIN |
363928372 |
Plan administrator’s name |
FOX RIVER PERIODONTICS, P.C. |
Plan administrator’s
address |
2075 BLACKBERRY DRIVE, GENEVA, IL, 60134 |
Administrator’s telephone number |
6302327400 |
Signature of
Role |
Employer/plan sponsor |
Date |
2011-07-26 |
Name of individual signing |
KAMBIZ NORUZI |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
FOX RIVER PERIODONTICS, P.C. 401(K) PROFIT SHARING PLAN
|
2010
|
363928372
|
2011-07-28
|
FOX RIVER PERIODONTICS, P.C.
|
13
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2006-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
6302327400
|
Plan sponsor’s
address |
2075 BLACKBERRY DRIVE, GENEVA, IL, 60134
|
Plan administrator’s name and address
Administrator’s EIN |
363928372 |
Plan administrator’s name |
FOX RIVER PERIODONTICS, P.C. |
Plan administrator’s
address |
2075 BLACKBERRY DRIVE, GENEVA, IL, 60134 |
Administrator’s telephone number |
6302327400 |
Signature of
Role |
Plan administrator |
Date |
2011-07-28 |
Name of individual signing |
KAMBIZ NORUZI |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
FOX RIVER PERIODONTICS, P.C. 401(K) PROFIT SHARING PLAN
|
2009
|
363928372
|
2010-07-28
|
FOX RIVER PERIODONTICS, P.C.
|
11
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2006-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
6302327400
|
Plan sponsor’s
address |
2075 BLACKBERRY DRIVE, GENEVA, IL, 60134
|
Plan administrator’s name and address
Administrator’s EIN |
363928372 |
Plan administrator’s name |
FOX RIVER PERIODONTICS, P.C. |
Plan administrator’s
address |
2075 BLACKBERRY DRIVE, GENEVA, IL, 60134 |
Administrator’s telephone number |
6302327400 |
Signature of
Role |
Plan administrator |
Date |
2010-07-28 |
Name of individual signing |
KAMBIZ NORUZI |
Valid signature |
Filed with authorized/valid electronic signature |
|
|