LOVES PARK CHIROPRACTIC CLINIC, S.C
|
2011
|
364297173
|
2012-05-10
|
LOVES PARK CHIROPRACTIC CLINIC, S.C
|
4
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2009-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8156337272
|
Plan sponsor’s
address |
421 RIVER LANE, LOVES PARK, IL, 61111
|
Plan administrator’s name and address
Administrator’s EIN |
364297173 |
Plan administrator’s name |
LOVES PARK CHIROPRACTIC CLINIC, S.C |
Plan administrator’s
address |
421 RIVER LANE, LOVES PARK, IL, 61111 |
Administrator’s telephone number |
8156337272 |
Signature of
Role |
Plan administrator |
Date |
2012-05-10 |
Name of individual signing |
DR. ANDREA K GAYLE KERKHOFF |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LOVES PARK CHIROPRACTIC CLINIC, S.C
|
2010
|
364297173
|
2011-06-06
|
LOVES PARK CHIROPRACTIC CLINIC, S.C
|
0
|
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2009-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8156337272
|
Plan sponsor’s
address |
421 RIVER LANE, LOVES PARK, IL, 61111
|
Plan administrator’s name and address
Administrator’s EIN |
364297173 |
Plan administrator’s name |
LOVES PARK CHIROPRACTIC CLINIC, S.C |
Plan administrator’s
address |
421 RIVER LANE, LOVES PARK, IL, 61111 |
Administrator’s telephone number |
8156337272 |
Signature of
Role |
Plan administrator |
Date |
2011-06-06 |
Name of individual signing |
DR. ANDREA K GAYLE KERKHOFF |
Valid signature |
Filed with incorrect/unrecognized electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2011-06-06 |
Name of individual signing |
SUSAN HOGAN |
Valid signature |
Filed with incorrect/unrecognized electronic signature |
|
|
LOVES PARK CHIROPRACTIC CLINIC, S.C
|
2010
|
364297173
|
2011-07-01
|
LOVES PARK CHIROPRACTIC CLINIC, S.C
|
0
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2009-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8156337272
|
Plan sponsor’s
address |
421 RIVER LANE, LOVES PARK, IL, 61111
|
Plan administrator’s name and address
Administrator’s EIN |
364297173 |
Plan administrator’s name |
LOVES PARK CHIROPRACTIC CLINIC, S.C |
Plan administrator’s
address |
421 RIVER LANE, LOVES PARK, IL, 61111 |
Administrator’s telephone number |
8156337272 |
Signature of
Role |
Plan administrator |
Date |
2011-07-01 |
Name of individual signing |
DR. ANDREA K GAYLE KERKHOFF |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2011-07-01 |
Name of individual signing |
SUSAN HOGAN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LOVES PARK CHIROPRACTIC CLINIC, S.C
|
2009
|
364297173
|
2010-09-02
|
LOVES PARK CHIROPRACTIC CLINIC, S.C
|
0
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2009-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8156337272
|
Plan sponsor’s
address |
421 RIVER LANE, LOVES PARK, IL, 61111
|
Plan administrator’s name and address
Administrator’s EIN |
364297173 |
Plan administrator’s name |
LOVES PARK CHIROPRACTIC CLINIC, S.C |
Plan administrator’s
address |
421 RIVER LANE, LOVES PARK, IL, 61111 |
Administrator’s telephone number |
8156337272 |
Signature of
Role |
Plan administrator |
Date |
2010-09-02 |
Name of individual signing |
FRANK HARRISON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|