|
PHYSIATRY PAIN MANAGEMENT, P.A. 401(K) PROFIT SHARING PLAN
|
2012
|
593591941
|
2013-06-20
|
PHYSIATRY PAIN MANAGEMENT, P.A.
|
4
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
002
|
| Effective date of plan |
2008-01-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
8508622912
|
| Plan sponsor’s
address |
907 MAR WALT DRIVE, SUITE 2013, FORT WALTON BEACH, FL, 32547
|
Signature of
| Role |
Plan administrator |
| Date |
2013-06-20 |
| Name of individual signing |
FRANK ZONDLO |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2013-06-20 |
| Name of individual signing |
FRANK ZONDLO |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
PHYSIATRY PAIN MANAGEMENT, P.A. 401(K) PROFIT SHARING PLAN
|
2011
|
593591941
|
2012-08-27
|
PHYSIATRY PAIN MANAGEMENT, P.A.
|
4
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
002
|
| Effective date of plan |
2008-01-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
8508622912
|
| Plan sponsor’s
address |
907 MAR WALT DRIVE, SUITE 2013, FORT WALTON BEACH, FL, 32547
|
Plan administrator’s name and address
| Administrator’s EIN |
593591941 |
| Plan administrator’s name |
PHYSIATRY PAIN MANAGEMENT, P.A. |
| Plan administrator’s
address |
907 MAR WALT DRIVE, SUITE 2013, FORT WALTON BEACH, FL, 32547 |
| Administrator’s telephone number |
8508622912 |
Signature of
| Role |
Plan administrator |
| Date |
2012-08-27 |
| Name of individual signing |
FRANK ZONDLO |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2012-08-27 |
| Name of individual signing |
FRANK ZONDLO |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
PHYSIATRY PAIN MANAGEMENT, P.A. 401(K) PROFIT SHARING PLAN
|
2010
|
593591941
|
2011-05-16
|
PHYSIATRY PAIN MANAGEMENT, P.A.
|
4
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
002
|
| Effective date of plan |
2008-01-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
8508622912
|
| Plan sponsor’s
address |
907 MAR WALT DRIVE, SUITE 2013, FORT WALTON BEACH, FL, 32547
|
Plan administrator’s name and address
| Administrator’s EIN |
593591941 |
| Plan administrator’s name |
PHYSIATRY PAIN MANAGEMENT, P.A. |
| Plan administrator’s
address |
907 MAR WALT DRIVE, SUITE 2013, FORT WALTON BEACH, FL, 32547 |
| Administrator’s telephone number |
8508622912 |
Signature of
| Role |
Plan administrator |
| Date |
2011-05-16 |
| Name of individual signing |
FRANK ZONDLO |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2011-05-16 |
| Name of individual signing |
FRANK ZONDLO |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
PHYSIATRY PAIN MANAGEMENT, P.A. 401(K) PROFIT SHARING PLAN
|
2009
|
593591941
|
2010-05-17
|
PHYSIATRY PAIN MANAGEMENT, P.A.
|
2
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
002
|
| Effective date of plan |
2008-01-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
8508622912
|
| Plan sponsor’s
address |
999 MAR WALT DRIVE, FORT WALTON BEACH, FL, 32547
|
Plan administrator’s name and address
| Administrator’s EIN |
593591941 |
| Plan administrator’s name |
PHYSIATRY PAIN MANAGEMENT, P.A. |
| Plan administrator’s
address |
999 MAR WALT DRIVE, FORT WALTON BEACH, FL, 32547 |
| Administrator’s telephone number |
8508622912 |
Signature of
| Role |
Plan administrator |
| Date |
2010-05-17 |
| Name of individual signing |
FRANK ZONDLO |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2010-05-17 |
| Name of individual signing |
FRANK ZONDLO |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
