|
MALCOLM L. HENLEY, D.D.S., P.A. DEFINED BENEFIT PLAN
|
2011
|
591940790
|
2012-10-01
|
MALCOLM L. HENLEY, D.D.S., P.A.
|
5
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
003
|
| Effective date of plan |
1998-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
4078563623
|
| Plan sponsor’s
address |
4872 WATERWITCH POINT DRIVE, ORLANDO, FL, 32806
|
Plan administrator’s name and address
| Administrator’s EIN |
591940790 |
| Plan administrator’s name |
MALCOLM L. HENLEY, D.D.S., P.A. |
| Plan administrator’s
address |
4872 WATERWITCH POINT DRIVE, ORLANDO, FL, 32806 |
| Administrator’s telephone number |
4078563623 |
Signature of
| Role |
Plan administrator |
| Date |
2012-09-28 |
| Name of individual signing |
MALCOLM HENLEY |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
MALCOLM L. HENLEY, D.D.S., P.A. DEFINED BENEFIT PLAN
|
2011
|
591940790
|
2012-04-30
|
MALCOLM L. HENLEY, D.D.S., P.A.
|
5
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
003
|
| Effective date of plan |
1998-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
4078563623
|
| Plan sponsor’s
address |
4872 WATERWITCH POINT DRIVE, ORLANDO, FL, 32806
|
Plan administrator’s name and address
| Administrator’s EIN |
591940790 |
| Plan administrator’s name |
MALCOLM L. HENLEY, D.D.S., P.A. |
| Plan administrator’s
address |
4872 WATERWITCH POINT DRIVE, ORLANDO, FL, 32806 |
| Administrator’s telephone number |
4078563623 |
Signature of
| Role |
Plan administrator |
| Date |
2012-04-30 |
| Name of individual signing |
MALCOLM HENLEY |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
MALCOLM L. HENLEY, D.D.S., P.A. DEFINED BENEFIT PLAN
|
2010
|
591940790
|
2011-08-15
|
MALCOLM L. HENLEY, D.D.S., P.A.
|
4
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
003
|
| Effective date of plan |
1998-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
4078563623
|
| Plan sponsor’s
address |
4872 WATERWITCH POINT DRIVE, ORLANDO, FL, 32806
|
Plan administrator’s name and address
| Administrator’s EIN |
591940790 |
| Plan administrator’s name |
MALCOLM L. HENLEY, D.D.S., P.A. |
| Plan administrator’s
address |
4872 WATERWITCH POINT DRIVE, ORLANDO, FL, 32806 |
| Administrator’s telephone number |
4078563623 |
Signature of
| Role |
Plan administrator |
| Date |
2011-08-15 |
| Name of individual signing |
MALCOLM HENLEY |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
MALCOLM L. HENLEY, D.D.S., P.A. DEFINED BENEFIT PLAN
|
2009
|
591940790
|
2010-10-12
|
MALCOLM L. HENLEY, D.D.S., P.A.
|
4
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
003
|
| Effective date of plan |
1998-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
4078563623
|
| Plan sponsor’s
address |
4872 WATERWITCH POINT DRIVE, ORLANDO, FL, 328067825
|
Plan administrator’s name and address
| Administrator’s EIN |
591940790 |
| Plan administrator’s name |
MALCOLM L. HENLEY, D.D.S., P.A. |
| Plan administrator’s
address |
4872 WATERWITCH POINT DRIVE, ORLANDO, FL, 328067825 |
| Administrator’s telephone number |
4078563623 |
Signature of
| Role |
Plan administrator |
| Date |
2010-10-12 |
| Name of individual signing |
MALCOLM HENLEY |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
