|
MICHAEL J. COSTELLO, M.D., P.A. RETIREMENT PLAN AND TRUST
|
2013
|
650349652
|
2014-08-14
|
MICHAEL J. COSTELLO, M.D., P.A.
|
8
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2004-01-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
7724614666
|
| Plan sponsor’s
address |
2215 NEBRASKA AVENUE, SUITE 3D, FORT PIERCE, FL, 34950
|
|
|
MICHAEL J. COSTELLO, M.D., P.A. RETIREMENT PLAN AND TRUST
|
2012
|
650349652
|
2013-10-07
|
MICHAEL J. COSTELLO, M.D., P.A.
|
8
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2004-01-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
7724614666
|
| Plan sponsor’s
address |
2215 NEBRASKA AVENUE, SUITE 3D, FORT PIERCE, FL, 34950
|
Signature of
| Role |
Plan administrator |
| Date |
2013-10-07 |
| Name of individual signing |
DAVID KITCOFF |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
MICHAEL J. COSTELLO, M.D., P.A. RETIREMENT PLAN AND TRUST
|
2011
|
650349652
|
2012-10-15
|
MICHAEL J. COSTELLO, M.D., P.A.
|
8
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2004-01-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
7724614666
|
| Plan sponsor’s
address |
2215 NEBRASKA AVENUE, SUITE 3D, FORT PIERCE, FL, 34950
|
Plan administrator’s name and address
| Administrator’s EIN |
650349652 |
| Plan administrator’s name |
MICHAEL J. COSTELLO, M.D., P.A. |
| Plan administrator’s
address |
2215 NEBRASKA AVENUE, SUITE 3D, FORT PIERCE, FL, 34950 |
| Administrator’s telephone number |
7724614666 |
Signature of
| Role |
Plan administrator |
| Date |
2012-10-15 |
| Name of individual signing |
DAVID KITCOFF |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
MICHAEL J. COSTELLO, M.D., P.A. RETIREMENT PLAN AND TRUST
|
2010
|
650349652
|
2011-09-07
|
MICHAEL J. COSTELLO, M.D., P.A.
|
11
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2004-01-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
7724614666
|
| Plan sponsor’s
address |
2215 NEBRASKA AVENUE, SUITE 3D, FORT PIERCE, FL, 34950
|
Plan administrator’s name and address
| Administrator’s EIN |
650349652 |
| Plan administrator’s name |
MICHAEL J. COSTELLO, M.D., P.A. |
| Plan administrator’s
address |
2215 NEBRASKA AVENUE, SUITE 3D, FORT PIERCE, FL, 34950 |
| Administrator’s telephone number |
7724614666 |
Signature of
| Role |
Plan administrator |
| Date |
2011-09-07 |
| Name of individual signing |
DAVID KITCOFF |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
MICHAEL J. COSTELLO, M.D., P.A. RETIREMENT PLAN AND TRUST
|
2009
|
650349652
|
2010-07-23
|
MICHAEL J. COSTELLO, M.D., P.A.
|
8
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2004-01-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
7724614666
|
| Plan sponsor’s
address |
2215 NEBRASKA AVENUE, SUITE 3D, FORT PIERCE, FL, 34950
|
Plan administrator’s name and address
| Administrator’s EIN |
650349652 |
| Plan administrator’s name |
MICHAEL J. COSTELLO, M.D., P.A. |
| Plan administrator’s
address |
2215 NEBRASKA AVENUE, SUITE 3D, FORT PIERCE, FL, 34950 |
| Administrator’s telephone number |
7724614666 |
Signature of
| Role |
Plan administrator |
| Date |
2010-07-23 |
| Name of individual signing |
MICHAEL COSTELLO |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
