EMPLOYEE BENEFIT PLAN OF JAY S. BERGER, M.D., P.A.
|
2016
|
592676400
|
2017-10-13
|
JAY S. BERGER, M.D., P.A.
|
6
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2013-03-01
|
Business code |
621111
|
Sponsor’s telephone number |
8634671117
|
Plan sponsor’s
address |
1713 HIGHWAY 441, NORTH SUITE D, OKEECHOBEE, FL, 34972
|
Signature of
Role |
Plan administrator |
Date |
2017-10-13 |
Name of individual signing |
JAY BERGER |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2017-10-13 |
Name of individual signing |
JAY BERGER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
EMPLOYEE BENEFIT PLAN OF JAY S. BERGER, M.D., P.A.
|
2015
|
592676400
|
2016-07-18
|
JAY S. BERGER, M.D., P.A.
|
6
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2013-03-01
|
Business code |
621111
|
Sponsor’s telephone number |
8634671117
|
Plan sponsor’s
address |
1713 HIGHWAY 441, NORTH SUITE D, OKEECHOBEE, FL, 34972
|
Signature of
Role |
Plan administrator |
Date |
2016-07-18 |
Name of individual signing |
JAY BERGER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
EMPLOYEE BENEFIT PLAN OF JAY S. BERGER, M.D., P.A.
|
2015
|
592676400
|
2016-07-14
|
JAY S. BERGER, M.D., P.A.
|
6
|
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2013-03-01
|
Business code |
621111
|
Sponsor’s telephone number |
8634671117
|
Plan sponsor’s
address |
1713 HIGHWAY 441, NORTH SUITE D, OKEECHOBEE, FL, 34972
|
Signature of
Role |
Plan administrator |
Date |
2016-07-14 |
Name of individual signing |
JAY BERGER |
Valid signature |
Filed with incorrect/unrecognized electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2016-07-14 |
Name of individual signing |
JAY BERGER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
EMPLOYEE BENEFIT PLAN OF JAY S. BERGER, M.D., P.A.
|
2014
|
592676400
|
2015-10-15
|
JAY S. BERGER, M.D., P.A.
|
6
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2013-03-01
|
Business code |
621111
|
Sponsor’s telephone number |
8634671117
|
Plan sponsor’s
address |
1713 HIGHWAY 441, NORTH SUITE D, OKEECHOBEE, FL, 34972
|
Signature of
Role |
Plan administrator |
Date |
2015-10-15 |
Name of individual signing |
JAY BERGER |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2015-10-15 |
Name of individual signing |
JAY BERGER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
EMPLOYEE BENEFIT PLAN OF JAY S. BERGER, M.D., P.A.
|
2013
|
592676400
|
2014-07-31
|
JAY S. BERGER, M.D., P.A.
|
0
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2013-03-01
|
Business code |
621111
|
Sponsor’s telephone number |
8634671117
|
Plan sponsor’s
address |
1713 HIGHWAY 441, NORTH SUITE D, OKEECHOBEE, FL, 34972
|
Signature of
Role |
Plan administrator |
Date |
2014-07-31 |
Name of individual signing |
BROOKE BERGER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|