YERGIN PULMONARY CLINIC, P.A. PROFIT SHARING PLAN AND TRUST
|
2014
|
591749210
|
2015-09-15
|
YERGIN PULMONARY CLINIC, P.A.
|
6
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1978-08-01
|
Business code |
621111
|
Sponsor’s telephone number |
9043960300
|
Plan sponsor’s
address |
3627 UNIVERSITY BLVD S., STE. 300, JACKSONVILLE, FL, 322164294
|
Signature of
Role |
Plan administrator |
Date |
2015-09-15 |
Name of individual signing |
BRUCE M. YERGIN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
YERGIN PULMONARY CLINIC, P.A. PROFIT SHARING PLAN AND TRUST
|
2014
|
591749210
|
2015-04-29
|
YERGIN PULMONARY CLINIC, P.A.
|
6
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1978-08-01
|
Business code |
621111
|
Sponsor’s telephone number |
9043960300
|
Plan sponsor’s
address |
3627 UNIVERSITY BLVD S., STE. 300, JACKSONVILLE, FL, 322164294
|
Signature of
Role |
Plan administrator |
Date |
2015-04-29 |
Name of individual signing |
BRUCE YERGIN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
YERGIN PULMONARY CLINIC, P.A. PROFIT SHARING PLAN AND TRUST
|
2013
|
591749210
|
2014-03-24
|
YERGIN PULMONARY CLINIC, P.A.
|
7
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1978-08-01
|
Business code |
621111
|
Sponsor’s telephone number |
9043960300
|
Plan sponsor’s
address |
3627 UNIVERSITY BLVD S., STE. 300, JACKSONVILLE, FL, 322164294
|
Signature of
Role |
Plan administrator |
Date |
2014-03-24 |
Name of individual signing |
BRUCE YERGIN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
YERGIN PULMONARY CLINIC, P.A. PROFIT SHARING PLAN AND TRUST
|
2012
|
591749210
|
2013-03-28
|
YERGIN PULMONARY CLINIC, P.A.
|
7
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1978-08-01
|
Business code |
621111
|
Sponsor’s telephone number |
9043960300
|
Plan sponsor’s
address |
3627 UNIVERSITY BLVD S., STE. 300, JACKSONVILLE, FL, 322164294
|
Plan administrator’s name and address
Administrator’s EIN |
591749210 |
Plan administrator’s name |
YERGIN PULMONARY CLINIC, P.A. |
Plan administrator’s
address |
3627 UNIVERSITY BLVD S., STE. 300, JACKSONVILLE, FL, 322164294 |
Administrator’s telephone number |
9043960300 |
Signature of
Role |
Plan administrator |
Date |
2013-03-28 |
Name of individual signing |
BRUCE YERGIN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
YERGIN PULMONARY CLINIC, P.A. PROFIT SHARING PLAN AND TRUST
|
2011
|
591749210
|
2012-04-16
|
YERGIN PULMONARY CLINIC, P.A.
|
7
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1978-08-01
|
Business code |
621111
|
Sponsor’s telephone number |
9043960300
|
Plan sponsor’s
address |
3627 UNIVERSITY BLVD S., STE. 300, JACKSONVILLE, FL, 322164294
|
Plan administrator’s name and address
Administrator’s EIN |
591749210 |
Plan administrator’s name |
YERGIN PULMONARY CLINIC, P.A. |
Plan administrator’s
address |
3627 UNIVERSITY BLVD S., STE. 300, JACKSONVILLE, FL, 322164294 |
Administrator’s telephone number |
9043960300 |
Signature of
Role |
Plan administrator |
Date |
2012-04-16 |
Name of individual signing |
BRUCE YERGIN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|