LOWELL F. CLARK, M.D., P.A. PROFIT SHARING AND 401(K) PLAN
|
2014
|
593688532
|
2015-10-08
|
LOWELL F. CLARK, M.D., P.A.
|
25
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2010-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
4075995900
|
Plan sponsor’s
address |
212 SOUTH FLORIDA STREET, BUSHNELL, FL, 33513
|
Signature of
Role |
Plan administrator |
Date |
2015-10-08 |
Name of individual signing |
LOWELL F. CLARK, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LOWELL F. CLARK, M.D., P.A. PROFIT SHARING AND 401(K) PLAN
|
2013
|
593688532
|
2014-08-28
|
LOWELL F. CLARK, M.D., P.A.
|
24
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2010-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
4075995900
|
Plan sponsor’s
address |
212 SOUTH FLORIDA STREET, BUSHNELL, FL, 33513
|
Signature of
Role |
Plan administrator |
Date |
2014-08-28 |
Name of individual signing |
LOWELL F. CLARK, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LOWELL F. CLARK, M.D., P.A. PROFIT SHARING AND 401(K) PLAN
|
2012
|
593688532
|
2013-07-16
|
LOWELL F. CLARK, M.D., P.A.
|
22
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2010-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
4075995900
|
Plan sponsor’s
address |
212 SOUTH FLORIDA STREET, BUSHNELL, FL, 33513
|
Signature of
Role |
Plan administrator |
Date |
2013-07-16 |
Name of individual signing |
LOWELL F. CLARK, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LOWELL F. CLARK, M.D., P.A. PROFIT SHARING AND 401(K) PLAN
|
2011
|
593688532
|
2012-09-08
|
LOWELL F. CLARK, M.D., P.A.
|
19
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2010-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
4075995900
|
Plan sponsor’s
address |
212 SOUTH FLORIDA STREET, BUSHNELL, FL, 33513
|
Plan administrator’s name and address
Administrator’s EIN |
593688532 |
Plan administrator’s name |
LOWELL F. CLARK, M.D., P.A. |
Plan administrator’s
address |
212 SOUTH FLORIDA STREET, BUSHNELL, FL, 33513 |
Administrator’s telephone number |
4075995900 |
Signature of
Role |
Plan administrator |
Date |
2012-09-08 |
Name of individual signing |
LOWELL F. CLARK, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
LOWELL F. CLARK, M.D., P.A. PROFIT SHARING AND 401(K) PLAN
|
2010
|
593688532
|
2011-09-24
|
LOWELL F. CLARK, M.D., P.A.
|
12
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2010-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
4075995900
|
Plan sponsor’s
address |
212 SOUTH FLORIDA STREET, BUSHNELL, FL, 33513
|
Plan administrator’s name and address
Administrator’s EIN |
593688532 |
Plan administrator’s name |
LOWELL F. CLARK, M.D., P.A. |
Plan administrator’s
address |
212 SOUTH FLORIDA STREET, BUSHNELL, FL, 33513 |
Administrator’s telephone number |
4075995900 |
Signature of
Role |
Plan administrator |
Date |
2011-09-24 |
Name of individual signing |
LOWELL F. CLARK, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|