|
GENESIS FAMILY PRACTICE, LLC 401(K) PS PLAN
|
2019
|
461045369
|
2020-08-20
|
GENESIS FAMILY PRACTICE, LLC
|
41
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2016-01-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
4073147539
|
| Plan sponsor’s
address |
1133 SAXON BOULEVARD, SUITE 100, ORANGE CITY, FL, 327638425
|
Signature of
| Role |
Plan administrator |
| Date |
2020-08-20 |
| Name of individual signing |
ANGELA M MYERS |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2020-08-20 |
| Name of individual signing |
ANGELA M MYERS |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
GENESIS FAMILY PRACTICE, LLC 401(K) PS PLAN
|
2018
|
461045369
|
2019-10-14
|
GENESIS FAMILY PRACTICE, LLC
|
20
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2016-01-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
4073147539
|
| Plan sponsor’s
address |
1133 SAXON BOULEVARD, SUITE 100, ORANGE CITY, FL, 327638425
|
Signature of
| Role |
Plan administrator |
| Date |
2019-10-14 |
| Name of individual signing |
ANGELA MYERS |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2019-10-14 |
| Name of individual signing |
ANGELA MYERS |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
GENESIS FAMILY PRACTICE, LLC 401(K) PROFIT SHARING PLAN
|
2017
|
461045369
|
2018-09-28
|
GENESIS FAMILY PRACTICE, LLC
|
14
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2016-01-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
3867479097
|
| Plan sponsor’s
address |
1133 SAXON BLVD, SUITE 100, ORANGE CITY, FL, 327638425
|
Signature of
| Role |
Plan administrator |
| Date |
2018-09-28 |
| Name of individual signing |
JAY CHANMUGAM |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
GENESIS FAMILY PRACTICE, LLC 401(K) PROFIT SHARING PLAN
|
2016
|
461045369
|
2018-10-12
|
GENESIS FAMILY PRACTICE, LLC
|
1
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2016-01-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
3867479097
|
| Plan sponsor’s
address |
1133 SAXON BLVD, SUITE 100, ORANGE CITY, FL, 327638425
|
Signature of
| Role |
Plan administrator |
| Date |
2018-10-12 |
| Name of individual signing |
JAY CHANMUGAM |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
GENESIS FAMILY PRACTICE, LLC 401(K) PROFIT SHARING PLAN
|
2016
|
461045369
|
2017-09-29
|
GENESIS FAMILY PRACTICE, LLC
|
1
|
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2016-01-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
3867479097
|
| Plan sponsor’s
address |
1133 SAXON BLVD, SUITE 100, ORANGE CITY, FL, 327638425
|
Signature of
| Role |
Plan administrator |
| Date |
2017-09-29 |
| Name of individual signing |
JAY CHANMUGAM |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
