|
ULTIMA DENTAL SYSTEMS 401(K)
|
2012
|
650273491
|
2013-04-24
|
JEREMY ETHAN INDUSTRIES
|
2
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2007-01-01
|
| Business code |
423800
|
| Sponsor’s telephone number |
9547729779
|
| Plan sponsor’s
address |
809 NW 57TH STREET, FORT LAUDERDALE, FL, 33309
|
Plan administrator’s name and address
| Administrator’s EIN |
650273491 |
| Plan administrator’s name |
JEREMY ETHAN INDUSTRIES |
| Plan administrator’s
address |
809 NW 57TH STREET, FORT LAUDERDALE, FL, 33309 |
| Administrator’s telephone number |
9547729779 |
Signature of
| Role |
Plan administrator |
| Date |
2013-04-24 |
| Name of individual signing |
JERRY MORRIS |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
ULTIMA DENTAL SYSTEMS 401(K)
|
2011
|
650273491
|
2012-06-25
|
JEREMY ETHAN INDUSTRIES
|
2
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2007-01-01
|
| Business code |
423800
|
| Sponsor’s telephone number |
9547729779
|
| Plan sponsor’s
address |
809 NW 57TH STREET, FORT LAUDERDALE, FL, 33309
|
Plan administrator’s name and address
| Administrator’s EIN |
650273491 |
| Plan administrator’s name |
JEREMY ETHAN INDUSTRIES |
| Plan administrator’s
address |
809 NW 57TH STREET, FORT LAUDERDALE, FL, 33309 |
| Administrator’s telephone number |
9547729779 |
Signature of
| Role |
Plan administrator |
| Date |
2012-06-25 |
| Name of individual signing |
JERRY MORRIS |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
ULTIMA DENTAL SYSTEMS 401(K) PLAN
|
2010
|
650273491
|
2011-03-29
|
JEREMY ETHAN INDUSTRIES
|
2
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2007-01-01
|
| Business code |
423800
|
| Sponsor’s telephone number |
9547729779
|
| Plan sponsor’s mailing address |
809 NW 57TH STREET, FORT LAUDERDALE, FL, 33309
|
| Plan sponsor’s
address |
809 NW 57TH STREET, FORT LAUDERDALE, FL, 33309
|
Plan administrator’s name and address
| Administrator’s EIN |
650273491 |
| Plan administrator’s name |
JEREMY ETHAN INDUSTRIES |
| Plan administrator’s
address |
809 NW 57TH STREET, FORT LAUDERDALE, FL, 33309 |
| Administrator’s telephone number |
9547729779 |
Number of participants as of the end of the plan year
| Active participants |
1 |
| Retired or separated participants receiving
benefits |
0 |
| Other
retired or separated participants entitled to future benefits |
1 |
| Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
| Number of
participants
with
account balances as of the end of the plan year |
2 |
| Number of participants that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
0 |
Signature of
| Role |
Plan administrator |
| Date |
2011-03-29 |
| Name of individual signing |
JERRY MORRIS |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
ULTIMA DENTAL SYSTEMS 401(K) PLAN
|
2010
|
650273491
|
2011-03-29
|
JEREMY ETHAN INDUSTRIES
|
2
|
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2007-01-01
|
| Business code |
423800
|
| Sponsor’s telephone number |
9547729779
|
| Plan sponsor’s mailing address |
809 NW 57TH STREET, FORT LAUDERDALE, FL, 33309
|
| Plan sponsor’s
address |
809 NW 57TH STREET, FORT LAUDERDALE, FL, 33309
|
Plan administrator’s name and address
| Administrator’s EIN |
650273491 |
| Plan administrator’s name |
JEREMY ETHAN INDUSTRIES |
| Plan administrator’s
address |
809 NW 57TH STREET, FORT LAUDERDALE, FL, 33309 |
| Administrator’s telephone number |
9547729779 |
Number of participants as of the end of the plan year
| Active participants |
1 |
| Retired or separated participants receiving
benefits |
0 |
| Other
retired or separated participants entitled to future benefits |
1 |
| Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
| Number of
participants
with
account balances as of the end of the plan year |
2 |
| Number of participants that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
0 |
Signature of
| Role |
Plan administrator |
| Date |
2011-03-29 |
| Name of individual signing |
JERRY MORRIS |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
ULTIMA DENTAL SYSTEMS 401(K) PLAN
|
2009
|
650273491
|
2010-04-21
|
JEREMY ETHAN INDUSTRIES
|
2
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2007-01-01
|
| Business code |
423800
|
| Sponsor’s telephone number |
9547729779
|
| Plan sponsor’s mailing address |
809 NW 57TH STREET, FORT LAUDERDALE, FL, 33309
|
| Plan sponsor’s
address |
809 NW 57TH STREET, FORT LAUDERDALE, FL, 33309
|
Plan administrator’s name and address
| Administrator’s EIN |
650273491 |
| Plan administrator’s name |
JEREMY ETHAN INDUSTRIES |
| Plan administrator’s
address |
809 NW 57TH STREET, FORT LAUDERDALE, FL, 33309 |
| Administrator’s telephone number |
9547729779 |
Number of participants as of the end of the plan year
| Active participants |
2 |
| Retired or separated participants receiving
benefits |
0 |
| Other
retired or separated participants entitled to future benefits |
0 |
| Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
| Number of
participants
with
account balances as of the end of the plan year |
2 |
| Number of participants that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
0 |
Signature of
| Role |
Plan administrator |
| Date |
2010-04-21 |
| Name of individual signing |
JERRY MORRIS |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
