PRAIRIE DENTAL ASSOCIATES 401(K) PROFIT-SHARING PLAN & TRUST
|
2023
|
463090138
|
2024-07-05
|
SIKORA & JACOBSEN, LLC
|
15
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2018-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
3096627722
|
Plan
sponsor’s DBA name |
PRAIRIE DENTAL ASSOCIATES
|
Plan sponsor’s
address |
3220 GERIG DRIVE, BLOOMINGTON, IL, 61704
|
Signature of
Role |
Plan administrator |
Date |
2024-07-05 |
Name of individual signing |
DANIEL R. JACOBSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2024-07-05 |
Name of individual signing |
DANIEL R. JACOBSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
PRAIRIE DENTAL ASSOCIATES 401(K) PROFIT-SHARING PLAN & TRUST
|
2022
|
463090138
|
2023-08-25
|
SIKORA & JACOBSEN, LLC
|
15
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2018-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
3096627722
|
Plan
sponsor’s DBA name |
PRAIRIE DENTAL ASSOCIATES
|
Plan sponsor’s
address |
3220 GERIG DRIVE, BLOOMINGTON, IL, 61704
|
Signature of
Role |
Plan administrator |
Date |
2023-08-25 |
Name of individual signing |
DANIEL R. JACOBSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2023-08-25 |
Name of individual signing |
DANIEL R. JACOBSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
PRAIRIE DENTAL ASSOCIATES 401(K) PROFIT-SHARING PLAN & TRUST
|
2021
|
463090138
|
2022-07-25
|
SIKORA & JACOBSEN, LLC
|
15
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2018-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
3096627722
|
Plan
sponsor’s DBA name |
PRAIRIE DENTAL ASSOCIATES
|
Plan sponsor’s
address |
3220 GERIG DRIVE, BLOOMINGTON, IL, 61704
|
Signature of
Role |
Plan administrator |
Date |
2022-07-25 |
Name of individual signing |
DANIEL R. JACOBSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2022-07-25 |
Name of individual signing |
DANIEL R. JACOBSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
PRAIRIE DENTAL ASSOCIATES 401(K) PROFIT-SHARING PLAN & TRUST
|
2020
|
463090138
|
2021-07-12
|
SIKORA & JACOBSEN, LLC
|
13
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2018-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
3096627722
|
Plan
sponsor’s DBA name |
PRAIRIE DENTAL ASSOCIATES
|
Plan sponsor’s
address |
3220 GERIG DRIVE, BLOOMINGTON, IL, 61704
|
Signature of
Role |
Plan administrator |
Date |
2021-07-12 |
Name of individual signing |
DANIEL R. JACOBSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2021-07-12 |
Name of individual signing |
DANIEL R. JACOBSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
PRAIRIE DENTAL ASSOCIATES 401(K) PROFIT-SHARING PLAN & TRUST
|
2019
|
463090138
|
2020-05-20
|
SIKORA & JACOBSEN, LLC
|
13
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2018-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
3096627722
|
Plan
sponsor’s DBA name |
PRAIRIE DENTAL ASSOCIATES
|
Plan sponsor’s
address |
3220 GERIG DRIVE, BLOOMINGTON, IL, 61704
|
Signature of
Role |
Plan administrator |
Date |
2020-05-20 |
Name of individual signing |
DANIEL R. JACOBSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2020-05-20 |
Name of individual signing |
DANIEL R. JACOBSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
PRAIRIE DENTAL ASSOCIATES 401(K) PROFIT-SHARING PLAN & TRUST
|
2018
|
463090138
|
2019-06-28
|
SIKORA & JACOBSEN, LLC
|
13
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2018-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
3096627722
|
Plan
sponsor’s DBA name |
PRAIRIE DENTAL ASSOCIATES
|
Plan sponsor’s
address |
3220 GERIG DRIVE, BLOOMINGTON, IL, 61704
|
Signature of
Role |
Plan administrator |
Date |
2019-06-28 |
Name of individual signing |
DANIEL R. JACOBSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2019-06-28 |
Name of individual signing |
DANIEL R. JACOBSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|