BRUCE W. SCAROLA, D. M. D. , M. S. D. , P. A. 401(K) PLAN
|
2019
|
593000670
|
2020-12-29
|
BRUCE W. SCAROLA, D.M.D.,M.S.D.,P.A
|
6
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1991-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8132544599
|
Plan sponsor’s
address |
544 RIVIERA DR., TAMPA, FL, 33606
|
Signature of
Role |
Plan administrator |
Date |
2020-12-29 |
Name of individual signing |
BRUCE W. SCAROLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2020-12-29 |
Name of individual signing |
BRUCE W. SCAROLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BRUCE W. SCAROLA, D. M. D. , M. S. D. , P. A. 401(K) PLAN
|
2019
|
593000670
|
2020-06-03
|
BRUCE W. SCAROLA, D.M.D.,M.S.D.,P.A
|
6
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1991-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8136546310
|
Plan sponsor’s
address |
213A KINGSWAY ROAD, NORTH, BRANDON, FL, 335104637
|
Signature of
Role |
Plan administrator |
Date |
2020-06-03 |
Name of individual signing |
BRUCE W. SCAROLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2020-06-03 |
Name of individual signing |
BRUCE W. SCAROLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BRUCE W. SCAROLA, D. M. D. , M. S. D. , P. A. 401(K) PLAN
|
2018
|
593000670
|
2019-09-03
|
BRUCE W. SCAROLA, D. M. D. , M. S. D. , P. A.
|
6
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1991-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8136546310
|
Plan sponsor’s
address |
213A KINGSWAY ROAD, NORTH, BRANDON, FL, 335104637
|
Signature of
Role |
Plan administrator |
Date |
2019-09-03 |
Name of individual signing |
BRUCE W. SCAROLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2019-09-03 |
Name of individual signing |
BRUCE W. SCAROLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BRUCE W. SCAROLA, D. M. D. , M. S. D. , P. A. 401(K) PLAN
|
2017
|
593000670
|
2018-07-10
|
BRUCE W. SCAROLA, D. M. D. , M. S. D. , P. A.
|
6
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1991-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8136546310
|
Plan sponsor’s
address |
213A KINGSWAY ROAD, NORTH, BRANDON, FL, 335104637
|
Signature of
Role |
Plan administrator |
Date |
2018-07-10 |
Name of individual signing |
BRUCE W. SCAROLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BRUCE W. SCAROLA, D. M. D. , M. S. D. , P. A. 401(K) PLAN
|
2016
|
593000670
|
2017-07-18
|
BRUCE W. SCAROLA, D. M. D. , M. S. D. , P. A.
|
6
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1991-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8136546310
|
Plan sponsor’s
address |
213 KINGSWAY ROAD, SUITE A, BRANDON, FL, 335104637
|
Signature of
Role |
Plan administrator |
Date |
2017-07-18 |
Name of individual signing |
BRUCE W. SCAROLA, DMD |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2017-07-18 |
Name of individual signing |
BRUCE W. SCAROLA, DMD |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BRUCE W. SCAROLA, D. M. D. , M. S. D. , P. A. 401(K) PLAN
|
2015
|
593000670
|
2016-10-05
|
BRUCE W. SCAROLA, D. M. D. , M. S. D. , P. A.
|
6
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1991-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8136546310
|
Plan sponsor’s
address |
213 KINGSWAY ROAD, SUITE A, BRANDON, FL, 335104637
|
Signature of
Role |
Plan administrator |
Date |
2016-10-05 |
Name of individual signing |
BRUCE W. SCAROLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2016-10-05 |
Name of individual signing |
BRUCE W. SCAROLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BRUCE W. SCAROLA, D. M. D. , M. S. D. , P. A. 401(K) PLAN
|
2014
|
593000670
|
2015-10-05
|
BRUCE W. SCAROLA, D. M. D. , M. S. D. , P. A.
|
6
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1991-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8136546310
|
Plan sponsor’s
address |
213 KINGSWAY ROAD, SUITE A, BRANDON, FL, 335104637
|
Signature of
Role |
Plan administrator |
Date |
2015-10-05 |
Name of individual signing |
BRUCE W. SCAROLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BRUCE W. SCAROLA, D.M.D., M.S.D., P.A. 401(K) PLAN
|
2013
|
593000670
|
2014-06-18
|
BRUCE W. SCAROLA, D.M.D., M.S.D., P.A.
|
6
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1991-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8136546310
|
Plan sponsor’s
address |
213 KINGSWAY ROAD, SUITE A, BRANDON, FL, 335104637
|
Signature of
Role |
Plan administrator |
Date |
2014-06-18 |
Name of individual signing |
BRUCE W. SCAROLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BRUCE W. SCAROLA, D.M.D., M.S.D., P.A. 401(K) PLAN
|
2012
|
593000670
|
2013-06-19
|
BRUCE W. SCAROLA, D.M.D., M.S.D., P.A.
|
9
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1991-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8136546310
|
Plan sponsor’s
address |
213 KINGSWAY ROAD, SUITE A, BRANDON, FL, 335104637
|
Signature of
Role |
Plan administrator |
Date |
2013-06-19 |
Name of individual signing |
BRUCE W. SCAROLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BRUCE W. SCAROLA, D.M.D., M.S.D., P.A. 401(K) PLAN
|
2011
|
593000670
|
2012-05-28
|
BRUCE W. SCAROLA, D.M.D., M.S.D., P.A.
|
8
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1991-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8136546310
|
Plan sponsor’s
address |
213 KINGSWAY ROAD, SUITE A, BRANDON, FL, 335104637
|
Plan administrator’s name and address
Administrator’s EIN |
593000670 |
Plan administrator’s name |
BRUCE W. SCAROLA, D.M.D., M.S.D., P.A. |
Plan administrator’s
address |
213 KINGSWAY ROAD, SUITE A, BRANDON, FL, 335104637 |
Administrator’s telephone number |
8136546310 |
Signature of
Role |
Plan administrator |
Date |
2012-05-28 |
Name of individual signing |
BRUCE W. SCAROLA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|