GULFSIDE SURGICAL ASSOCIATES 401(K) PLAN
|
2011
|
202619427
|
2012-07-05
|
GULFSIDE SURGICAL ASSOCIATES, P.L.
|
3
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2005-07-01
|
Business code |
621111
|
Sponsor’s telephone number |
7278630008
|
Plan sponsor’s
address |
1745 DAYLILY DRIVE, TRINITY, FL, 34655
|
Plan administrator’s name and address
Administrator’s EIN |
202619427 |
Plan administrator’s name |
GULFSIDE SURGICAL ASSOCIATES, P.L. |
Plan administrator’s
address |
1745 DAYLILY DRIVE, TRINITY, FL, 34655 |
Administrator’s telephone number |
7278630008 |
Signature of
Role |
Plan administrator |
Date |
2012-07-05 |
Name of individual signing |
CHRISTINE L MENDONCA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GULFSIDE SURGICAL ASSOCIATES 401(K) PLAN
|
2011
|
202619427
|
2012-12-26
|
GULFSIDE SURGICAL ASSOCIATES, P.L.
|
4
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2005-07-01
|
Business code |
621111
|
Sponsor’s telephone number |
8137273312
|
Plan sponsor’s
address |
1745 DAYLILY DRIVE, TRINITY, FL, 34655
|
Plan administrator’s name and address
Administrator’s EIN |
202619427 |
Plan administrator’s name |
GULFSIDE SURGICAL ASSOCIATES, P.L. |
Plan administrator’s
address |
1745 DAYLILY DRIVE, TRINITY, FL, 34655 |
Administrator’s telephone number |
8137273312 |
Signature of
Role |
Plan administrator |
Date |
2012-12-26 |
Name of individual signing |
CHRISTINE L MENDONCA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2012-12-26 |
Name of individual signing |
HUGO L. MENDONCA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GULFSIDE SURGICAL ASSOCIATES 401(K) PLAN
|
2010
|
202619427
|
2011-12-09
|
GULFSIDE SURGICAL ASSOCIATES, P.L.
|
3
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2005-07-01
|
Business code |
621111
|
Sponsor’s telephone number |
7278611441
|
Plan sponsor’s
address |
1745 DAYLILY DRIVE, TRINITY, FL, 34655
|
Plan administrator’s name and address
Administrator’s EIN |
202619427 |
Plan administrator’s name |
GULFSIDE SURGICAL ASSOCIATES, P.L. |
Plan administrator’s
address |
1745 DAYLILY DRIVE, TRINITY, FL, 34655 |
Administrator’s telephone number |
7278611441 |
Signature of
Role |
Plan administrator |
Date |
2011-10-05 |
Name of individual signing |
HUGO MENDONCA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
GULFSIDE SURGICAL ASSOCIATES 401(K) PLAN
|
2010
|
202619427
|
2011-10-05
|
GULFSIDE SURGICAL ASSOCIATES, P.L.
|
3
|
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2005-07-01
|
Business code |
621111
|
Sponsor’s telephone number |
7278611441
|
Plan sponsor’s
address |
1745 DAYLILY DRIVE, TRINITY, FL, 34655
|
Plan administrator’s name and address
Administrator’s EIN |
202619427 |
Plan administrator’s name |
GULFSIDE SURGICAL ASSOCIATES, P.L. |
Plan administrator’s
address |
1745 DAYLILY DRIVE, TRINITY, FL, 34655 |
Administrator’s telephone number |
7278611441 |
Signature of
Role |
Plan administrator |
Date |
2011-10-05 |
Name of individual signing |
HUGO MENDONCA |
Valid signature |
Filed with incorrect/unrecognized electronic signature |
|
|
GULFSIDE SURGICAL ASSOCIATES 401(K) PLAN
|
2009
|
202619427
|
2010-10-12
|
GULFSIDE SURGICAL ASSOCIATES, P.L.
|
8
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2005-07-01
|
Business code |
621111
|
Sponsor’s telephone number |
7278611441
|
Plan sponsor’s
address |
7614 JACQUE ROAD, SUITE B, HUDSON, FL, 34667
|
Plan administrator’s name and address
Administrator’s EIN |
202619427 |
Plan administrator’s name |
GULFSIDE SURGICAL ASSOCIATES, P.L. |
Plan administrator’s
address |
7614 JACQUE ROAD, SUITE B, HUDSON, FL, 34667 |
Administrator’s telephone number |
7278611441 |
Signature of
Role |
Plan administrator |
Date |
2010-10-12 |
Name of individual signing |
HUGO MENDONCA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2010-10-12 |
Name of individual signing |
HUGO MENDONCA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|