|
EXCEPTIONAL DENTAL OF SAINT PETERSBURG 401(K) PLAN
|
2023
|
823725715
|
2024-05-14
|
EXCEPTIONAL DENTAL OF SAINT PETERSBURG
|
13
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2018-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
7273883429
|
| Plan sponsor’s
address |
3238 4TH ST N, ST. PETERSBURG, FL, 33704
|
Plan administrator’s name and address
| Administrator’s EIN |
474474775 |
| Plan administrator’s name |
GUIDELINE, INC. |
| Plan administrator’s
address |
1412 CHAPIN AVENUE, BURLINGAME, CA, 94010 |
| Administrator’s telephone number |
8882283491 |
Signature of
| Role |
Plan administrator |
| Date |
2024-05-14 |
| Name of individual signing |
QIAN LIU |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
EXCEPTIONAL DENTAL OF SAINT PETERSBURG 401(K) PLAN
|
2022
|
823725715
|
2023-05-27
|
EXCEPTIONAL DENTAL OF SAINT PETERSBURG
|
14
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2018-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
7273883429
|
| Plan sponsor’s
address |
3238 4TH ST N, ST. PETERSBURG, FL, 33704
|
Plan administrator’s name and address
| Administrator’s EIN |
474474775 |
| Plan administrator’s name |
GUIDELINE, INC. |
| Plan administrator’s
address |
1412 CHAPIN AVENUE, BURLINGAME, CA, 94010 |
| Administrator’s telephone number |
8882283491 |
Signature of
| Role |
Plan administrator |
| Date |
2023-05-27 |
| Name of individual signing |
CHRISTINE RIMER |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
EXCEPTIONAL DENTAL OF SAINT PETERSBURG 401(K) PLAN
|
2021
|
823725715
|
2022-10-05
|
EXCEPTIONAL DENTAL OF SAINT PETERSBURG
|
11
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2018-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
7273883429
|
| Plan sponsor’s
address |
3238 4TH ST N, ST. PETERSBURG, FL, 33704
|
Plan administrator’s name and address
| Administrator’s EIN |
474474775 |
| Plan administrator’s name |
GUIDELINE, INC. |
| Plan administrator’s
address |
1645 E 6TH STREET, SUITE 200, AUSTIN, TX, 78702 |
| Administrator’s telephone number |
8882283491 |
Signature of
| Role |
Plan administrator |
| Date |
2022-10-05 |
| Name of individual signing |
CHRISTINE RIMER |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
EXCEPTIONAL DENTAL OF SAINT PETERSBURG 401(K) PROFIT SHARING PLAN & TRUST
|
2021
|
823725715
|
2022-06-28
|
EXCEPTIONAL DENTAL OF SAINT PETERSBURG
|
9
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2018-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
7273883429
|
| Plan sponsor’s
address |
3238 4TH ST N, ST PETERSBURG, FL, 337042127
|
Signature of
| Role |
Plan administrator |
| Date |
2022-06-28 |
| Name of individual signing |
THUY NGUYEN |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2022-06-28 |
| Name of individual signing |
THUY NGUYEN |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
EXCEPTIONAL DENTAL OF SAINT PETERSBURG 401(K) PLAN
|
2020
|
823725715
|
2021-10-13
|
EXCEPTIONAL DENTAL OF SAINT PETERSBURG
|
11
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2018-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
7273883429
|
| Plan sponsor’s
address |
3238 4TH ST N, ST. PETERSBURG, FL, 33704
|
Plan administrator’s name and address
| Administrator’s EIN |
474474775 |
| Plan administrator’s name |
GUIDELINE, INC. |
| Plan administrator’s
address |
1645 E 6TH STREET, SUITE 200, AUSTIN, TX, 78702 |
| Administrator’s telephone number |
8882283491 |
Signature of
| Role |
Plan administrator |
| Date |
2021-10-13 |
| Name of individual signing |
CAROL HO |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
