BEENA KOPPUZHA, M.D., P.A. 401(K) PLAN & TRUST
|
2022
|
202065231
|
2023-10-11
|
BEENA KOPPUZHA, M.D., P.A.
|
9
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2013-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
9414756568
|
Plan sponsor’s
address |
3937 S ACCESS ROAD, ENGLEWOOD, FL, 34224
|
Signature of
Role |
Plan administrator |
Date |
2023-10-11 |
Name of individual signing |
BEENA KOPPUZHA, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BEENA KOPPUZHA, M.D., P.A. 401(K) PLAN & TRUST
|
2021
|
202065231
|
2023-02-02
|
BEENA KOPPUZHA, M.D., P.A.
|
8
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2013-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
9414756568
|
Plan sponsor’s
address |
3937 S ACCESS ROAD, ENGLEWOOD, FL, 34224
|
Signature of
Role |
Plan administrator |
Date |
2023-02-02 |
Name of individual signing |
BEENA KOPPUZHA, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BEENA KOPPUZHA, M.D., P.A. 401(K) PLAN & TRUST
|
2020
|
202065231
|
2023-05-26
|
BEENA KOPPUZHA, M.D., P.A.
|
8
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2013-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
9414756568
|
Plan sponsor’s
address |
1141 S. MCCALL ROAD, ENGLEWOOD, FL, 34223
|
Signature of
Role |
Plan administrator |
Date |
2023-05-26 |
Name of individual signing |
BEENA KOPPUZHA, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BEENA KOPPUZHA, M.D., P.A. 401(K) PLAN & TRUST
|
2020
|
202065231
|
2021-10-14
|
BEENA KOPPUZHA, M.D., P.A.
|
8
|
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2013-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
9414756568
|
Plan sponsor’s
address |
1141 S. MCCALL ROAD, ENGLEWOOD, FL, 34223
|
Signature of
Role |
Plan administrator |
Date |
2021-10-14 |
Name of individual signing |
BEENA KOPPUZHA, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BEENA KOPPUZHA, M.D., P.A. 401(K) PLAN & TRUST
|
2019
|
202065231
|
2020-10-15
|
BEENA KOPPUZHA, M.D., P.A.
|
8
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2013-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
9414756568
|
Plan sponsor’s
address |
1141 S. MCCALL ROAD, ENGLEWOOD, FL, 34223
|
Signature of
Role |
Plan administrator |
Date |
2020-10-15 |
Name of individual signing |
BEENA KOPPUZHA, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BEENA KOPPUZHA, M.D., P.A. 401(K) PLAN & TRUST
|
2018
|
202065231
|
2019-10-10
|
BEENA KOPPUZHA, M.D., P.A.
|
9
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2013-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
9414756568
|
Plan sponsor’s
address |
1141 S. MCCALL ROAD, ENGLEWOOD, FL, 34223
|
Signature of
Role |
Plan administrator |
Date |
2019-10-10 |
Name of individual signing |
BEENA KOPPUZHA, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BEENA KOPPUZHA, M.D., P.A. 401(K) PLAN & TRUST
|
2017
|
202065231
|
2018-10-10
|
BEENA KOPPUZHA, M.D., P.A.
|
7
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2013-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
9414756568
|
Plan sponsor’s
address |
1141 S. MCCALL ROAD, ENGLEWOOD, FL, 34223
|
Signature of
Role |
Plan administrator |
Date |
2018-10-10 |
Name of individual signing |
BEENA KOPPUZHA, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BEENA KOPPUZHA, M.D., P.A. 401(K) PLAN & TRUST
|
2016
|
202065231
|
2018-01-31
|
BEENA KOPPUZHA, M.D., P.A.
|
6
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2013-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
9414756568
|
Plan sponsor’s
address |
1141 S. MCCALL ROAD, ENGLEWOOD, FL, 34223
|
Signature of
Role |
Plan administrator |
Date |
2018-01-31 |
Name of individual signing |
BEENA KOPPUZHA, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BEENA KOPPUZHA, M.D., P.A. 401(K) PLAN & TRUST
|
2015
|
202065231
|
2016-10-14
|
BEENA KOPPUZHA, M.D., P.A.
|
7
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2013-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
9414756568
|
Plan sponsor’s
address |
1141 S. MCCALL ROAD, ENGLEWOOD, FL, 34223
|
Signature of
Role |
Plan administrator |
Date |
2016-10-14 |
Name of individual signing |
BEENA KOPPUZHA, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BEENA KOPPUZHA, M.D., P.A. 401(K) PLAN & TRUST
|
2014
|
202065231
|
2015-10-12
|
BEENA KOPPUZHA, M.D., P.A.
|
7
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2013-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
9414756568
|
Plan sponsor’s
address |
1141 S. MCCALL ROAD, ENGLEWOOD, FL, 34223
|
Signature of
Role |
Plan administrator |
Date |
2015-10-12 |
Name of individual signing |
BEENA KOPPUZHA, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|