RJC SIGNATURE RETIREE HEALTH BENEFIT TRUST
|
2012
|
270155525
|
2013-07-19
|
RICHARD J CLAYDON DDS, LLC
|
1
|
|
File |
View Page
|
Three-digit plan number (PN) |
511
|
Effective date of plan |
2009-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
3093102238
|
Plan sponsor’s
address |
25097 EAGLE POINTE, HUDSON, IL, 61748
|
Signature of
Role |
Plan administrator |
Date |
2013-07-19 |
Name of individual signing |
NICOLE FALCO WATSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
RJC SIGNATURE RETIREE HEALTH BENEFIT TRUST
|
2011
|
270155525
|
2012-06-05
|
RICHARD J. CLAYDON DDS, LLC
|
1
|
|
File |
View Page
|
Three-digit plan number (PN) |
511
|
Effective date of plan |
2009-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
3093102238
|
Plan sponsor’s
address |
25097 EAGLE POINTE, HUDSON, IL, 61748
|
Plan administrator’s name and address
Administrator’s EIN |
270155525 |
Plan administrator’s name |
RICHARD J. CLAYDON DDS, LLC |
Plan administrator’s
address |
25097 EAGLE POINTE, HUDSON, IL, 61748 |
Administrator’s telephone number |
3093102238 |
Signature of
Role |
Plan administrator |
Date |
2012-06-05 |
Name of individual signing |
PAUL DOUCETTE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
RJC SIGNATURE RETIREE HEALTH BENEFIT TRUST
|
2010
|
270155525
|
2011-08-01
|
RICHARD J. CLAYDON DDS, LLC
|
1
|
|
File |
View Page
|
Three-digit plan number (PN) |
511
|
Effective date of plan |
2009-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
3093102238
|
Plan sponsor’s
address |
25097 EAGLE POINTE, HUDSON, IL, 61748
|
Plan administrator’s name and address
Administrator’s EIN |
270155525 |
Plan administrator’s name |
RICHARD J. CLAYDON DDS, LLC |
Plan administrator’s
address |
25097 EAGLE POINTE, HUDSON, IL, 61748 |
Administrator’s telephone number |
3093102238 |
Signature of
Role |
Plan administrator |
Date |
2011-08-01 |
Name of individual signing |
PAUL DOUCETTE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|