GUERRERO & SALIB, M.D., P.A. DEFINED BENEFIT PLAN
|
2012
|
591669478
|
2013-12-09
|
GUERRERO & SALIB, M.D., P.A.
|
2
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2004-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
3212676796
|
Plan sponsor’s
address |
500 N. WASHINGTON AVE., STE 206, TITUSVILLE, FL, 32796
|
Signature of
Role |
Plan administrator |
Date |
2013-12-09 |
Name of individual signing |
TATIANA POMBO |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-12-09 |
Name of individual signing |
TATIANA POMBO |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GUERRERO & SALIB, M.D., P.A. DEFINED BENEFIT PLAN
|
2012
|
591669478
|
2013-06-24
|
GUERRERO & SALIB, M.D., P.A.
|
3
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2004-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
3212676796
|
Plan sponsor’s
address |
500 N. WASHINGTON AVE., STE 206, TITUSVILLE, FL, 32796
|
Signature of
Role |
Plan administrator |
Date |
2013-06-24 |
Name of individual signing |
TATIANA POMBO |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-06-24 |
Name of individual signing |
TATIANA POMBO |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GUERRERO & SALIB, M.D., P.A. DEFINED BENEFIT PLAN
|
2011
|
591669478
|
2012-09-19
|
GUERRERO & SALIB, M.D., P.A.
|
3
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2004-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
3212676796
|
Plan sponsor’s
address |
500 N. WASHINGTON AVE., STE 206, TITUSVILLE, FL, 32796
|
Plan administrator’s name and address
Administrator’s EIN |
591669478 |
Plan administrator’s name |
GUERRERO & SALIB, M.D., P.A. |
Plan administrator’s
address |
500 N. WASHINGTON AVE., STE 206, TITUSVILLE, FL, 32796 |
Administrator’s telephone number |
3212676796 |
Signature of
Role |
Plan administrator |
Date |
2012-09-19 |
Name of individual signing |
TATIANA POMBO |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2012-09-19 |
Name of individual signing |
TATIANA POMBO |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GUERRERO & SALIB, M.D., P.A. DEFINED BENEFIT PLAN
|
2010
|
591669478
|
2011-06-30
|
GUERRERO & SALIB, M.D., P.A.
|
4
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2004-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
3212676796
|
Plan sponsor’s
address |
500 N. WASHINGTON AVE., STE 206, TITUSVILLE, FL, 32796
|
Plan administrator’s name and address
Administrator’s EIN |
591669478 |
Plan administrator’s name |
GUERRERO & SALIB, M.D., P.A. |
Plan administrator’s
address |
500 N. WASHINGTON AVE., STE 206, TITUSVILLE, FL, 32796 |
Administrator’s telephone number |
3212676796 |
Signature of
Role |
Plan administrator |
Date |
2011-06-30 |
Name of individual signing |
TATIANA CHAVEZ |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2011-06-30 |
Name of individual signing |
TATIANA CHAVEZ |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GUERRERO & SALIB, M.D., P.A. DEFINED BENEFIT PLAN
|
2009
|
591669478
|
2010-09-15
|
GUERRERO & SALIB, M.D., P.A.
|
2
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2004-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
3212676796
|
Plan sponsor’s
address |
415 SOUTH CARPENTER ROAD, TITUSVILLE, FL, 32796
|
Plan administrator’s name and address
Administrator’s EIN |
591669478 |
Plan administrator’s name |
GUERRERO & SALIB, M.D., P.A. |
Plan administrator’s
address |
415 SOUTH CARPENTER ROAD, TITUSVILLE, FL, 32796 |
Administrator’s telephone number |
3212676796 |
Signature of
Role |
Plan administrator |
Date |
2010-09-15 |
Name of individual signing |
JULIE BURGESS |
Valid signature |
Filed with authorized/valid electronic signature |
|
|