| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
1980-10-01
|
| Business code |
621310
|
| Sponsor’s telephone number |
2172243757
|
| Plan sponsor’s
address |
3701 E LAKE CTR STE 1, QUINCY, IL, 623055840
|
Plan administrator’s name and address
| Administrator’s EIN |
364144748 |
| Plan administrator’s name |
PRIMARY CARE PHYSICIANS, S.C. |
| Plan administrator’s
address |
3701 E LAKE CTR STE 1, QUINCY, IL, 623055840 |
| Administrator’s telephone number |
2172243757 |
Signature of
| Role |
Plan administrator |
| Date |
2010-12-28 |
| Name of individual signing |
DR. TERRY SHAW |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
