| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2005-06-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2179325266
|
| Plan sponsor’s
address |
6117 TIMBERWOLFE DRIVE, CARBON, IL, 62034
|
Plan administrator’s name and address
| Administrator’s EIN |
202043759 |
| Plan administrator’s name |
CASEY FAMILY DENTAL, LLC |
| Plan administrator’s
address |
6117 TIMBERWOLFE DRIVE, CARBON, IL, 62034 |
| Administrator’s telephone number |
2179325266 |
Signature of
| Role |
Plan administrator |
| Date |
2010-05-13 |
| Name of individual signing |
DAVID GUILBEAULT |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2010-05-13 |
| Name of individual signing |
DAVID GUILBEAULT |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
