ELM STREET PEDIATRICS, S.C. RETIREMENT PLAN
|
2012
|
364266539
|
2013-07-03
|
ELM STREET PEDIATRICS, S.C.
|
16
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2004-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8475014040
|
Plan sponsor’s
address |
572 LINCOLN AVENUE, SUITE 3, WINNETKA, IL, 60093
|
Signature of
Role |
Plan administrator |
Date |
2013-07-03 |
Name of individual signing |
SUSAN NELSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-07-03 |
Name of individual signing |
SUSAN NELSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
ELM STREET PEDIATRICS, S.C. RETIREMENT PLAN
|
2011
|
364266539
|
2012-07-19
|
ELM STREET PEDIATRICS, S.C.
|
14
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2004-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8475014040
|
Plan sponsor’s
address |
572 LINCOLN AVE. SUITE 3, WINNETKA, IL, 60093
|
Plan administrator’s name and address
Administrator’s EIN |
364266539 |
Plan administrator’s name |
ELM STREET PEDIATRICS, S.C. |
Plan administrator’s
address |
572 LINCOLN AVE. SUITE 3, WINNETKA, IL, 60093 |
Administrator’s telephone number |
8475014040 |
Signature of
Role |
Plan administrator |
Date |
2012-07-19 |
Name of individual signing |
SUSAN NELSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2012-07-19 |
Name of individual signing |
SUSAN NELSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
ELM STREET PEDIATRICS, S.C. RETIREMENT PLAN
|
2010
|
364266539
|
2011-10-13
|
ELM STREET PEDIATRICS, S.C.
|
15
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2004-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8475014040
|
Plan sponsor’s
address |
716 ELM STREET, WINNETKA, IL, 60093
|
Plan administrator’s name and address
Administrator’s EIN |
364266539 |
Plan administrator’s name |
ELM STREET PEDIATRICS, S.C. |
Plan administrator’s
address |
716 ELM STREET, WINNETKA, IL, 60093 |
Administrator’s telephone number |
8475014040 |
Signature of
Role |
Plan administrator |
Date |
2011-10-13 |
Name of individual signing |
SUSAN NELSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2011-10-13 |
Name of individual signing |
SUSAN NELSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
ELM STREET PEDIATRICS, S.C. RETIREMENT PLAN
|
2009
|
364266539
|
2010-10-04
|
ELM STREET PEDIATRICS, S.C.
|
15
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2004-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8475014040
|
Plan sponsor’s
address |
716 ELM STREET, WINNETKA, IL, 60093
|
Plan administrator’s name and address
Administrator’s EIN |
364266539 |
Plan administrator’s name |
ELM STREET PEDIATRICS, S.C. |
Plan administrator’s
address |
716 ELM STREET, WINNETKA, IL, 60093 |
Administrator’s telephone number |
8475014040 |
Signature of
Role |
Plan administrator |
Date |
2010-10-04 |
Name of individual signing |
SUSAN J. NELSON, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2010-10-04 |
Name of individual signing |
SUSAN J. NELSON, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|