|
HEMANT N. SHAH MD PA 401K PROFIT SHARING PLAN
|
2014
|
593375335
|
2015-10-10
|
HEMANT N. SHAH, M.D., P.A.
|
4
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
002
|
| Effective date of plan |
1997-12-25
|
| Business code |
621111
|
| Sponsor’s telephone number |
7278496850
|
| Plan sponsor’s
address |
3919 CAPITOL DRIVE, PALM HARBOR, FL, 34685
|
Signature of
| Role |
Plan administrator |
| Date |
2015-10-10 |
| Name of individual signing |
HEMANT N. SHAH |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
HEMANT N. SHAH, M.D., P.A. DEFINED BENEFIT PLAN
|
2012
|
593375335
|
2013-06-02
|
HEMANT N. SHAH, M.D., P.A.
|
6
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
003
|
| Effective date of plan |
2008-01-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
7278496850
|
| Plan sponsor’s
address |
3306 U.S. HIGHWAY 19, HOLIDAY, FL, 346910000
|
Signature of
| Role |
Plan administrator |
| Date |
2013-06-02 |
| Name of individual signing |
HEMANT SHAH |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2013-06-02 |
| Name of individual signing |
HEMANT SHAH |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
HEMANT N. SHAH, M.D., P.A. DEFINED BENEFIT PLAN
|
2011
|
593375335
|
2012-10-09
|
HEMANT N. SHAH, M.D., P.A.
|
3
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
002
|
| Effective date of plan |
2008-01-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
7278496850
|
| Plan sponsor’s
address |
3306 U.S. HIGHWAY 19, HOLIDAY, FL, 346910000
|
Plan administrator’s name and address
| Administrator’s EIN |
593375335 |
| Plan administrator’s name |
HEMANT N. SHAH, M.D., P.A. |
| Plan administrator’s
address |
3306 U.S. HIGHWAY 19, HOLIDAY, FL, 346910000 |
| Administrator’s telephone number |
7278496850 |
Signature of
| Role |
Plan administrator |
| Date |
2012-10-09 |
| Name of individual signing |
HEMANT SHAH |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2012-10-09 |
| Name of individual signing |
HEMANT SHAH |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
HEMANT N. SHAH, M.D., P.A. DEFINED BENEFIT PLAN
|
2010
|
593375335
|
2011-09-28
|
HEMANT N. SHAH, M.D., P.A.
|
3
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
002
|
| Effective date of plan |
2008-01-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
7278496850
|
| Plan sponsor’s
address |
3306 U.S. HIGHWAY 19, HOLIDAY, FL, 346910000
|
Plan administrator’s name and address
| Administrator’s EIN |
593375335 |
| Plan administrator’s name |
HEMANT N. SHAH, M.D., P.A. |
| Plan administrator’s
address |
3306 U.S. HIGHWAY 19, HOLIDAY, FL, 346910000 |
| Administrator’s telephone number |
7278496850 |
Signature of
| Role |
Plan administrator |
| Date |
2011-09-28 |
| Name of individual signing |
HEMANT SHAH |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2011-09-28 |
| Name of individual signing |
HEMANT SHAH |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
