NISSEN DDS 401(K) TRUST
|
2015
|
208141778
|
2016-10-04
|
LARRY W. NISSEN, DDS PA
|
7
|
|
File |
View Page
|
Three-digit plan number (PN) |
003
|
Effective date of plan |
2005-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
3214525500
|
Plan sponsor’s
address |
280 SYKES CREEK PKWY., STE C, MERRITT ISLAND, FL, 32953
|
|
NISSEN DDS 401(K) TRUST
|
2014
|
208141778
|
2015-08-28
|
LARRY W. NISSEN, DDS PA
|
7
|
|
File |
View Page
|
Three-digit plan number (PN) |
003
|
Effective date of plan |
2005-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
3214525500
|
Plan sponsor’s
address |
280 SYKES CREEK PKWY., STE C, MERRITT ISLAND, FL, 32953
|
|
NISSEN DDS 401(K) TRUST
|
2013
|
208141778
|
2014-09-29
|
LARRY W. NISSEN, DDS PA
|
7
|
|
File |
View Page
|
Three-digit plan number (PN) |
003
|
Effective date of plan |
2005-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
3214525500
|
Plan sponsor’s
address |
280 SYKES CREEK PKWY., STE C, MERRITT ISLAND, FL, 32953
|
|
NISSEN DDS 401(K) TRUST
|
2012
|
208141778
|
2013-10-04
|
LARRY W. NISSEN, DDS PA
|
7
|
|
File |
View Page
|
Three-digit plan number (PN) |
003
|
Effective date of plan |
2005-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
3214525500
|
Plan sponsor’s
address |
280 SYKES CREEK PKWY., STE C, MERRITT ISLAND, FL, 32953
|
Signature of
Role |
Plan administrator |
Date |
2013-10-04 |
Name of individual signing |
LARRY W. NISSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-10-04 |
Name of individual signing |
LARRY W. NISSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
NISSEN DDS 401(K) TRUST
|
2011
|
208141778
|
2012-10-03
|
LARRY W. NISSEN, DDS PA
|
7
|
|
File |
View Page
|
Three-digit plan number (PN) |
003
|
Effective date of plan |
2005-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
3214525500
|
Plan sponsor’s
address |
280 SYKES CREEK PKWY., STE C, MERRITT ISLAND, FL, 32953
|
Plan administrator’s name and address
Administrator’s EIN |
208141778 |
Plan administrator’s name |
LARRY W. NISSEN, DDS PA |
Plan administrator’s
address |
280 SYKES CREEK PKWY., STE C, MERRITT ISLAND, FL, 32953 |
Administrator’s telephone number |
3214525500 |
Signature of
Role |
Plan administrator |
Date |
2012-10-03 |
Name of individual signing |
LARRY W. NISSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2012-10-03 |
Name of individual signing |
LARRY W. NISSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
NISSEN DDS 401(K) TRUST
|
2010
|
208141778
|
2011-10-03
|
LARRY W. NISSEN, DDS PA
|
7
|
|
File |
View Page
|
Three-digit plan number (PN) |
003
|
Effective date of plan |
2005-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
3214525500
|
Plan sponsor’s
address |
280 SYKES CREEK PKWY., STE C, MERRITT ISLAND, FL, 32953
|
Plan administrator’s name and address
Administrator’s EIN |
208141778 |
Plan administrator’s name |
LARRY W. NISSEN, DDS PA |
Plan administrator’s
address |
280 SYKES CREEK PKWY., STE C, MERRITT ISLAND, FL, 32953 |
Administrator’s telephone number |
3214525500 |
Signature of
Role |
Plan administrator |
Date |
2011-10-03 |
Name of individual signing |
LARRY W. NISSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2011-10-03 |
Name of individual signing |
LARRY W. NISSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
NISSEN DDS 401(K) TRUST
|
2009
|
208141778
|
2010-09-24
|
LARRY W. NISSEN, DDS PA
|
7
|
|
File |
View Page
|
Three-digit plan number (PN) |
003
|
Effective date of plan |
2005-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
3214525500
|
Plan sponsor’s
address |
280 SYKES CREEK PKWY., STE C, MERRITT ISLAND, FL, 32953
|
Plan administrator’s name and address
Administrator’s EIN |
208141778 |
Plan administrator’s name |
LARRY W. NISSEN, DDS PA |
Plan administrator’s
address |
280 SYKES CREEK PKWY., STE C, MERRITT ISLAND, FL, 32953 |
Administrator’s telephone number |
3214525500 |
Signature of
Role |
Plan administrator |
Date |
2010-09-24 |
Name of individual signing |
LARRY W. NISSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2010-09-24 |
Name of individual signing |
LARRY W. NISSEN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|