HEALTHSOURCE OF ROCKFORD INC. 401(K) PROFIT SHARING PLAN & TRUST
|
2010
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262052342
|
2013-03-14
|
HEALTHSOURCE OF ROCKFORD INC.
|
3
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|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2009-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8158717212
|
Plan sponsor’s
address |
7445 EAST STATE ST., ROCKFORD, IL, 61108
|
Plan administrator’s name and address
Administrator’s EIN |
262052342 |
Plan administrator’s name |
HEALTHSOURCE OF ROCKFORD INC. |
Plan administrator’s
address |
7445 EAST STATE ST., ROCKFORD, IL, 61108 |
Administrator’s telephone number |
8158717212 |
Signature of
Role |
Plan administrator |
Date |
2013-03-14 |
Name of individual signing |
MATTHEW BANKORD |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-03-14 |
Name of individual signing |
MATTHEW BANKORD |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
HEALTHSOURCE OF ROCKFORD INC
|
2009
|
262052342
|
2010-09-29
|
HEALTHSOURCE OF ROCKFORD INC
|
5
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2009-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8158717212
|
Plan sponsor’s
address |
7445 E STATE STREET, ROCKFORD, IL, 61108
|
Plan administrator’s name and address
Administrator’s EIN |
262052342 |
Plan administrator’s name |
HEALTHSOURCE OF ROCKFORD INC |
Plan administrator’s
address |
7445 E STATE STREET, ROCKFORD, IL, 61108 |
Administrator’s telephone number |
8158717212 |
Signature of
Role |
Plan administrator |
Date |
2010-09-29 |
Name of individual signing |
HEALTHSOURCE OF ROCKFORD INC |
Valid signature |
Filed with authorized/valid electronic signature |
|
|