SHORELINE PERIODONTICS, P.C. 401(K) PROFIT SHARING PLAN
|
2016
|
060861436
|
2017-07-27
|
SHORELINE PERIODONTICS, P.C.
|
12
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
1970-05-01
|
Business code |
621210
|
Sponsor’s telephone number |
8604435298
|
Plan sponsor’s
address |
190 HEMPSTEAD STREET, NEW LONDON, CT, 06320
|
Signature of
Role |
Plan administrator |
Date |
2017-07-27 |
Name of individual signing |
GREGORY A. TOBACK, DMD |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
SHORELINE PERIODONTICS, P.C. 401(K) PROFIT SHARING PLAN
|
2015
|
060861436
|
2016-05-10
|
SHORELINE PERIODONTICS, P.C.
|
12
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
1970-05-01
|
Business code |
621210
|
Sponsor’s telephone number |
8604435298
|
Plan sponsor’s
address |
190 HEMPSTEAD STREET, NEW LONDON, CT, 06320
|
|
SHORELINE PERIODONTICS, P.C. 401(K) PROFIT SHARING PLAN
|
2014
|
060861436
|
2015-03-30
|
SHORELINE PERIODONTICS, P.C.
|
15
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
1970-05-01
|
Business code |
621210
|
Sponsor’s telephone number |
8604435298
|
Plan sponsor’s
address |
190 HEMPSTEAD STREET, NEW LONDON, CT, 06320
|
Signature of
Role |
Plan administrator |
Date |
2015-03-30 |
Name of individual signing |
GREGORY A. TOBACK, DMD |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
SHORELINE PERIODONTICS, P.C. 401(K) PROFIT SHARING PLAN
|
2013
|
060861436
|
2014-03-13
|
SHORELINE PERIODONTICS, P.C.
|
16
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
1970-05-01
|
Business code |
621210
|
Sponsor’s telephone number |
8604435298
|
Plan sponsor’s
address |
190 HEMPSTEAD STREET, NEW LONDON, CT, 06320
|
Signature of
Role |
Plan administrator |
Date |
2014-03-13 |
Name of individual signing |
GREGORY A. TOBACK, DMD |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
SHORELINE PERIODONTICS, P.C. 401(K) PROFIT SHARING PLAN
|
2012
|
060861436
|
2013-07-22
|
SHORELINE PERIODONTICS, P.C.
|
17
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
1970-05-01
|
Business code |
621210
|
Sponsor’s telephone number |
8604435298
|
Plan sponsor’s
address |
190 HEMPSTEAD STREET, NEW LONDON, CT, 06320
|
Signature of
Role |
Plan administrator |
Date |
2013-07-22 |
Name of individual signing |
GREGORY A. TOBACK, DMD |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
SHORELINE PERIODONTICS, P.C. 401(K) PROFIT SHARING PLAN
|
2011
|
060861436
|
2012-08-06
|
SHORELINE PERIODONTICS, P.C.
|
18
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
1970-05-01
|
Business code |
621210
|
Sponsor’s telephone number |
8604435298
|
Plan sponsor’s
address |
190 HEMPSTEAD STREET, NEW LONDON, CT, 06320
|
Plan administrator’s name and address
Administrator’s EIN |
060861436 |
Plan administrator’s name |
SHORELINE PERIODONTICS, P.C. |
Plan administrator’s
address |
190 HEMPSTEAD STREET, NEW LONDON, CT, 06320 |
Administrator’s telephone number |
8604435298 |
Signature of
Role |
Plan administrator |
Date |
2012-08-06 |
Name of individual signing |
GREGORY A. TOBACK, DMD |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
SHORELINE PERIODONTICS, P.C. 401(K) PROFIT SHARING PLAN
|
2010
|
060861436
|
2011-09-28
|
SHORELINE PERIODONTICS, P.C.
|
18
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
1970-05-01
|
Business code |
621210
|
Sponsor’s telephone number |
8604435298
|
Plan sponsor’s
address |
190 HEMPSTEAD STREET, NEW LONDON, CT, 06320
|
Plan administrator’s name and address
Administrator’s EIN |
060861436 |
Plan administrator’s name |
SHORELINE PERIODONTICS, P.C. |
Plan administrator’s
address |
190 HEMPSTEAD STREET, NEW LONDON, CT, 06320 |
Administrator’s telephone number |
8604435298 |
Signature of
Role |
Plan administrator |
Date |
2011-09-28 |
Name of individual signing |
GREGORY TOBACK |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
SHORELINE PERIODONTICS, P.C. 401(K) PROFIT SHARING PLAN
|
2009
|
060861436
|
2010-10-11
|
SHORELINE PERIODONTICS, P.C.
|
25
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
1970-05-01
|
Business code |
621210
|
Sponsor’s telephone number |
8604435298
|
Plan sponsor’s
address |
190 HEMPSTEAD STREET, NEW LONDON, CT, 06320
|
Plan administrator’s name and address
Administrator’s EIN |
060861436 |
Plan administrator’s name |
SHORELINE PERIODONTICS, P.C. |
Plan administrator’s
address |
190 HEMPSTEAD STREET, NEW LONDON, CT, 06320 |
Administrator’s telephone number |
8604435298 |
Signature of
Role |
Plan administrator |
Date |
2010-10-11 |
Name of individual signing |
GREGORY TOBACK |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2010-10-11 |
Name of individual signing |
GREGORY TOBACK |
Valid signature |
Filed with authorized/valid electronic signature |
|
|