|
LAKE MARY OBSTETRICS & GYNECOLOGY DEFINED BENEFIT PLAN
|
2011
|
593757422
|
2012-06-11
|
EDMUND BOULTING, P.A.
|
5
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2007-01-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
4073232727
|
| Plan sponsor’s
address |
P.O. BOX 954021, LAKE MARY, FL, 32746
|
Plan administrator’s name and address
| Administrator’s EIN |
593757422 |
| Plan administrator’s name |
EDMUND BOULTING, P.A. |
| Plan administrator’s
address |
P.O. BOX 954021, LAKE MARY, FL, 32746 |
| Administrator’s telephone number |
4073232727 |
Signature of
| Role |
Plan administrator |
| Date |
2012-06-11 |
| Name of individual signing |
CAMERON KELLY |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
LAKE MARY OBSTETRICS & GYNECOLOGY DEFINED BENEFIT PLAN
|
2010
|
593757422
|
2011-10-14
|
EDMUND BOULTING, P.A.
|
5
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2007-01-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
4073232727
|
| Plan sponsor’s
address |
2500 WEST LAKE MARY BOULEVARD, SUITE 206, LAKE MARY, FL, 327463501
|
Plan administrator’s name and address
| Administrator’s EIN |
593757422 |
| Plan administrator’s name |
EDMUND BOULTING, P.A. |
| Plan administrator’s
address |
2500 WEST LAKE MARY BOULEVARD, SUITE 206, LAKE MARY, FL, 327463501 |
| Administrator’s telephone number |
4073232727 |
Signature of
| Role |
Plan administrator |
| Date |
2011-10-14 |
| Name of individual signing |
CAMERON KELLY |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
LAKE MARY OBSTETRICS & GYNECOLOGY DEFINED BENEFIT PLAN
|
2009
|
593757422
|
2010-11-09
|
EDMUND BOULTING, P.A.
|
4
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2007-01-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
4073232727
|
| Plan sponsor’s
address |
2500 WEST LAKE MARY BOULEVARD, SUITE 206, LAKE MARY, FL, 327463501
|
Plan administrator’s name and address
| Administrator’s EIN |
593757422 |
| Plan administrator’s name |
EDMUND BOULTING, P.A. |
| Plan administrator’s
address |
2500 WEST LAKE MARY BOULEVARD, SUITE 206, LAKE MARY, FL, 327463501 |
| Administrator’s telephone number |
4073232727 |
Signature of
| Role |
Plan administrator |
| Date |
2010-11-09 |
| Name of individual signing |
CAMERON KELLY |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
