BLANE T. SHATKIN, M.D., P.A. PROFIT SHARING PLAN
|
2016
|
650555661
|
2017-02-08
|
BLANE T. SHATKIN, M.D., P.A.
|
2
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2006-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
9543849997
|
Plan sponsor’s
address |
2200 S. OCEAN LANE, APT 705, FT. LAUDERDALE, FL, 33316
|
|
BLANE T. SHATKIN, M.D., P.A. PROFIT SHARING PLAN
|
2015
|
650555661
|
2016-06-15
|
BLANE T. SHATKIN, M.D., P.A.
|
3
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2006-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
9543849997
|
Plan sponsor’s
address |
1604 TOWN CENTER BLVD., SUITE C, WESTON, FL, 33326
|
|
BLANE T. SHATKIN, M.D., P.A. PROFIT SHARING PLAN
|
2012
|
650555661
|
2013-07-02
|
BLANE T. SHATKIN, M.D., P.A.
|
3
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2006-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
9543849997
|
Plan sponsor’s
address |
1604 TOWN CENTER BLVD., SUITE C, WESTON, FL, 33326
|
Signature of
Role |
Plan administrator |
Date |
2013-07-02 |
Name of individual signing |
BLANE T. SHATKIN, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BLANE T. SHATKIN, M.D., P.A. PROFIT SHARING PLAN
|
2011
|
650555661
|
2012-04-11
|
BLANE T. SHATKIN, M.D., P.A.
|
4
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2006-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
9543849997
|
Plan sponsor’s
address |
1604 TOWN CENTER BLVD., SUITE C, WESTON, FL, 33326
|
Plan administrator’s name and address
Administrator’s EIN |
650555661 |
Plan administrator’s name |
BLANE T. SHATKIN, M.D., P.A. |
Plan administrator’s
address |
1604 TOWN CENTER BLVD., SUITE C, WESTON, FL, 33326 |
Administrator’s telephone number |
9543849997 |
Signature of
Role |
Plan administrator |
Date |
2012-04-11 |
Name of individual signing |
BLANE T. SHATKIN, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BLANE T. SHATKIN, M.D., P.A. PROFIT SHARING PLAN
|
2010
|
650555661
|
2011-04-08
|
BLANE T. SHATKIN, M.D., P.A.
|
3
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2006-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
9543849997
|
Plan sponsor’s
address |
1604 TOWN CENTER BLVD., SUITE C, WESTON, FL, 33326
|
Plan administrator’s name and address
Administrator’s EIN |
650555661 |
Plan administrator’s name |
BLANE T. SHATKIN, M.D., P.A. |
Plan administrator’s
address |
1604 TOWN CENTER BLVD., SUITE C, WESTON, FL, 33326 |
Administrator’s telephone number |
9543849997 |
Signature of
Role |
Plan administrator |
Date |
2011-04-08 |
Name of individual signing |
BLANE T. SHATKIN, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|