COAST DENTAL SERVICES, INC. CONSOLIDATED WELFARE PLAN
|
2015
|
593136131
|
2016-07-27
|
COAST DENTAL SERVICES INC
|
1504
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1996-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8132881999
|
Plan
sponsor’s DBA name |
COAST DENTAL, DENTISTS RX
|
Plan sponsor’s mailing address |
4010 BOY SCOUT BLVD, SUITE 1100, TAMPA, FL, 33607
|
Plan sponsor’s
address |
4010 BOY SCOUT BLVD, SUITE 1100, TAMPA, FL, 33607
|
Number of participants as of the end of the plan year
Active participants |
1346 |
Retired or separated participants receiving
benefits |
14 |
Other
retired or separated participants entitled to future benefits |
0 |
Signature of
Role |
Plan administrator |
Date |
2016-07-27 |
Name of individual signing |
MICHELE ZUCCO |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
COAST DENTAL SERVICES, INC. CONSOLIDATED WELFARE PLAN
|
2014
|
593136131
|
2016-02-08
|
COAST DENTAL SERVICES, INC.
|
1888
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1996-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8132881999
|
Plan
sponsor’s DBA name |
INTELIDENT SOLUTIONS
|
Plan sponsor’s mailing address |
4010 BOY SCOUT BLVD, SUITE 1100, TAMPA, FL, 33607
|
Plan sponsor’s
address |
4010 BOY SCOUT BLVD, SUITE 1100, TAMPA, FL, 33607
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2016-02-08 |
Name of individual signing |
MICHELE ZUCCO |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2016-02-08 |
Name of individual signing |
MICHELE ZUCCO |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
COAST DENTAL SERVICES, INC. CONSOLIDATED WELFARE PLAN
|
2014
|
593136131
|
2015-11-02
|
COAST DENTAL SERVICES, INC.
|
1888
|
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1996-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8132881999
|
Plan
sponsor’s DBA name |
INTELIDENT SOLUTIONS
|
Plan sponsor’s mailing address |
4010 BOY SCOUT BLVD, SUITE 1100, TAMPA, FL, 33607
|
Plan sponsor’s
address |
4010 BOY SCOUT BLVD, SUITE 1100, TAMPA, FL, 33607
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2015-11-02 |
Name of individual signing |
MICHELE ZUCCO |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
COAST DENTAL SERVICES, INC. CONSOLIDATED WELFARE PLAN
|
2013
|
593136131
|
2014-07-18
|
COAST DENTAL SERVICES, INC.
|
1812
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1996-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8132881999
|
Plan sponsor’s mailing address |
4010 BOYSCOUT BOULEVARD, TAMPA, FL, 33607
|
Plan sponsor’s
address |
4010 BOYSCOUT BOULEVARD, TAMPA, FL, 33607
|
Plan administrator’s name and address
Administrator’s EIN |
593136131 |
Plan administrator’s name |
COAST DENTAL SERVICES, INC. |
Plan administrator’s
address |
4010 BOYSCOUT BOULEVARD, TAMPA, FL, 33607 |
Administrator’s telephone number |
8132881999 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2014-07-17 |
Name of individual signing |
ELLIOTT WILLIS |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
COAST DENTAL SERVICES, INC. CONSOLIDATED WELFARE PLAN
|
2012
|
593136131
|
2013-09-25
|
COAST DENTAL SERVICES, INC.
|
1615
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1996-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8132881999
|
Plan sponsor’s mailing address |
4010 BOYSCOUT BOULEVARD, TAMPA, FL, 33607
|
Plan sponsor’s
address |
4010 BOYSCOUT BOULEVARD, TAMPA, FL, 33607
|
Plan administrator’s name and address
Administrator’s EIN |
593136131 |
Plan administrator’s name |
COAST DENTAL SERVICES, INC. |
Plan administrator’s
address |
4010 BOYSCOUT BOULEVARD, TAMPA, FL, 33607 |
Administrator’s telephone number |
8132881999 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2013-09-25 |
Name of individual signing |
SAMANTHA BARBER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
COAST DENTAL SERVICES, INC. CONSOLIDATED WELFARE PLAN
|
2011
|
593136131
|
2012-09-12
|
COAST DENTAL SERVICES, INC.
|
1226
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1996-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8132881999
|
Plan sponsor’s mailing address |
4010 BOYSCOUT BOULEVARD, TAMPA, FL, 33607
|
Plan sponsor’s
address |
4010 BOYSCOUT BOULEVARD, TAMPA, FL, 33607
|
Plan administrator’s name and address
Administrator’s EIN |
593136131 |
Plan administrator’s name |
COAST DENTAL SERVICES, INC. |
Plan administrator’s
address |
4010 BOYSCOUT BOULEVARD, TAMPA, FL, 33607 |
Administrator’s telephone number |
8132881999 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2012-09-12 |
Name of individual signing |
SAMANTHA BARBER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
COAST DENTAL SERVICES, INC 401(K) PLAN
|
2010
|
593136131
|
2011-10-17
|
COAST DENTAL SERVICES, INC.
|
999
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1998-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8132881999
|
Plan sponsor’s mailing address |
ONE METRO CENTER, 4010 BOY SCOUT BLVD, SUITE 1100, TAMPA, FL, 33607
|
Plan sponsor’s
address |
ONE METRO CENTER, 4010 BOY SCOUT BLVD, SUITE 1100, TAMPA, FL, 33607
|
Plan administrator’s name and address
Administrator’s EIN |
593136131 |
Plan administrator’s name |
COAST DENTAL SERVICES, INC. |
Plan administrator’s
address |
ONE METRO CENTER, 4010 BOY SCOUT BLVD, SUITE 1100, TAMPA, FL, 33607 |
Administrator’s telephone number |
8132881999 |
Number of participants as of the end of the plan year
Active participants |
895 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
107 |
Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
Number of
participants
with
account balances as of the end of the plan year |
350 |
Number of participants that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
0 |
Signature of
Role |
Plan administrator |
Date |
2011-10-17 |
Name of individual signing |
DON KELLY |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
COAST DENTAL SERVICES, INC. CONSOLIDATED WELFARE PLAN
|
2010
|
593136131
|
2011-08-16
|
COAST DENTAL SERVICES, INC.
|
1254
|
|
File |
View Page
|
Three-digit plan number (PN) |
501
|
Effective date of plan |
1996-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8132881999
|
Plan sponsor’s mailing address |
4010 BOYSCOUT BOULEVARD, TAMPA, FL, 33607
|
Plan sponsor’s
address |
4010 BOYSCOUT BOULEVARD, TAMPA, FL, 33607
|
Plan administrator’s name and address
Administrator’s EIN |
593136131 |
Plan administrator’s name |
COAST DENTAL SERVICES, INC. |
Plan administrator’s
address |
4010 BOYSCOUT BOULEVARD, TAMPA, FL, 33607 |
Administrator’s telephone number |
8132881999 |
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2011-08-15 |
Name of individual signing |
SAMANTHA BARBER |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
COAST DENTAL SERVICES, INC 401(K) PLAN
|
2009
|
593136131
|
2011-02-10
|
COAST DENTAL SERVICES, INC.
|
1076
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1998-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8132881999
|
Plan sponsor’s mailing address |
ONE METRO CENTER, 4010 BOY SCOUT BLVD, SUITE 1100, TAMPA, FL, 33607
|
Plan sponsor’s
address |
ONE METRO CENTER, 4010 BOY SCOUT BLVD, SUITE 1100, TAMPA, FL, 33607
|
Plan administrator’s name and address
Administrator’s EIN |
593136131 |
Plan administrator’s name |
COAST DENTAL SERVICES, INC. |
Plan administrator’s
address |
ONE METRO CENTER, 4010 BOY SCOUT BLVD, SUITE 1100, TAMPA, FL, 33607 |
Administrator’s telephone number |
8132881999 |
Number of participants as of the end of the plan year
Active participants |
903 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
96 |
Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
Number of
participants
with
account balances as of the end of the plan year |
342 |
Number of participants that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
0 |
Signature of
Role |
Plan administrator |
Date |
2011-02-10 |
Name of individual signing |
DON KELLY |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
COAST DENTAL SERVICES, INC 401(K) PLAN
|
2009
|
593136131
|
2010-10-13
|
COAST DENTAL SERVICES, INC.
|
1076
|
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1998-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8132881999
|
Plan sponsor’s mailing address |
ONE METRO CENTER, 4010 BOY SCOUT BLVD, SUITE 1100, TAMPA, FL, 33607
|
Plan sponsor’s
address |
ONE METRO CENTER, 4010 BOY SCOUT BLVD, SUITE 1100, TAMPA, FL, 33607
|
Plan administrator’s name and address
Administrator’s EIN |
593136131 |
Plan administrator’s name |
COAST DENTAL SERVICES, INC. |
Plan administrator’s
address |
ONE METRO CENTER, 4010 BOY SCOUT BLVD, SUITE 1100, TAMPA, FL, 33607 |
Administrator’s telephone number |
8132881999 |
Number of participants as of the end of the plan year
Active participants |
903 |
Retired or separated participants receiving
benefits |
0 |
Other
retired or separated participants entitled to future benefits |
96 |
Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
Number of
participants
with
account balances as of the end of the plan year |
342 |
Number of participants that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
0 |
Signature of
Role |
Plan administrator |
Date |
2010-10-13 |
Name of individual signing |
DON KELLY |
Valid signature |
Filed with authorized/valid electronic signature |
|
|