LAKE FOREST INTERNAL MEDICINE, LTD. 401 (K) PLAN
|
2012
|
364457960
|
2013-05-28
|
LAKE FOREST INTERNAL MEDICINE, LTD.
|
17
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2002-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8478163084
|
Plan sponsor’s
address |
1800 HOLLISTER DRIVE, SUITE 211, LIBERTYVILLE, IL, 60048
|
Signature of
Role |
Plan administrator |
Date |
2013-05-28 |
Name of individual signing |
ELLIOT MILLER |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-05-28 |
Name of individual signing |
ELLIOT MILLER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LAKE FOREST INTERNAL MEDICINE, LTD. 401 (K) PLAN
|
2011
|
364457960
|
2012-05-09
|
LAKE FOREST INTERNAL MEDICINE, LTD.
|
15
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2002-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8478163084
|
Plan sponsor’s
address |
1800 HOLLISTER DRIVE, SUITE 211, LIBERTYVILLE, IL, 60048
|
Plan administrator’s name and address
Administrator’s EIN |
364457960 |
Plan administrator’s name |
LAKE FOREST INTERNAL MEDICINE, LTD. |
Plan administrator’s
address |
1800 HOLLISTER DRIVE, SUITE 211, LIBERTYVILLE, IL, 60048 |
Administrator’s telephone number |
8478163084 |
Signature of
Role |
Plan administrator |
Date |
2012-05-09 |
Name of individual signing |
MILLER ELLIOT |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2012-05-09 |
Name of individual signing |
MILLER ELLIOT |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LAKE FOREST INTERNAL MEDICINE, LTD. 401 (K) PLAN
|
2010
|
364457960
|
2011-07-07
|
LAKE FOREST INTERNAL MEDICINE, LTD.
|
15
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2002-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8478163084
|
Plan sponsor’s
address |
1800 HOLLISTER DRIVE, SUITE 211, LIBERTYVIL, IL, 60048
|
Plan administrator’s name and address
Administrator’s EIN |
364457960 |
Plan administrator’s name |
LAKE FOREST INTERNAL MEDICINE, LTD. |
Plan administrator’s
address |
1800 HOLLISTER DRIVE, SUITE 211, LIBERTYVIL, IL, 60048 |
Administrator’s telephone number |
8478163084 |
Signature of
Role |
Plan administrator |
Date |
2011-07-07 |
Name of individual signing |
ELLIOT MILLER |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2011-07-07 |
Name of individual signing |
ELLIOT MILLER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LAKE FOREST INTERNAL MEDICINE, LTD. 401 (K) PLAN
|
2009
|
364457960
|
2010-08-10
|
LAKE FOREST INTERNAL MEDICINE, LTD.
|
14
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2002-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8478163084
|
Plan sponsor’s
address |
1800 HOLLISTER DRIVE, SUITE 211, LIBERTYVILLE, IL, 60048
|
Plan administrator’s name and address
Administrator’s EIN |
364457960 |
Plan administrator’s name |
LAKE FOREST INTERNAL MEDICINE, LTD. |
Plan administrator’s
address |
1800 HOLLISTER DRIVE, SUITE 211, LIBERTYVILLE, IL, 60048 |
Administrator’s telephone number |
8478163084 |
Signature of
Role |
Plan administrator |
Date |
2010-08-10 |
Name of individual signing |
ELLIOT MILLER |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2010-08-10 |
Name of individual signing |
ELLIOT MILLER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|