|
BROOKFIELD DENTAL ASSOCIATES LLC 401K PLAN
|
2011
|
201899479
|
2012-10-12
|
BROOKFIELD DENTAL ASSOCIATES LLC
|
2
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2004-11-01
|
| Business code |
621210
|
| Plan sponsor’s
address |
304 FEDERAL ROAD, BROOKFIELD, CT, 06804
|
Plan administrator’s name and address
| Administrator’s EIN |
201899479 |
| Plan administrator’s name |
BROOKFIELD DENTAL ASSOCIATES LLC |
| Plan administrator’s
address |
304 FEDERAL ROAD, BROOKFIELD, CT, 06804 |
Signature of
| Role |
Plan administrator |
| Date |
2012-10-12 |
| Name of individual signing |
RICHARD FISHER |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2012-10-12 |
| Name of individual signing |
RICHARD FISHER |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
BROOKFIELD DENTAL ASSOCIATES LLC 401K PLAN
|
2010
|
201899479
|
2011-10-14
|
BROOKFIELD DENTAL ASSOCIATES LLC
|
2
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2004-11-01
|
| Business code |
621210
|
| Plan sponsor’s mailing address |
304 FEDERAL ROAD, BROOKFIELD, CT, 06804
|
| Plan sponsor’s
address |
304 FEDERAL ROAD, BROOKFIELD, CT, 06804
|
Plan administrator’s name and address
| Administrator’s EIN |
201899479 |
| Plan administrator’s name |
BROOKFIELD DENTAL ASSOCIATES LLC |
| Plan administrator’s
address |
304 FEDERAL ROAD, BROOKFIELD, CT, 06804 |
Number of participants as of the end of the plan year
| Active participants |
2 |
| Number of
participants
with
account balances as of the end of the plan year |
2 |
Signature of
| Role |
Plan administrator |
| Date |
2011-10-14 |
| Name of individual signing |
RICHARD FISHER |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2011-10-14 |
| Name of individual signing |
RICHARD FISHER |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
BROOKFIELD DENTAL ASSOCIATES LLC 401K PLAN
|
2009
|
201899479
|
2010-10-13
|
BROOKFIELD DENTAL ASSOCIATES LLC
|
2
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2004-11-01
|
| Business code |
621210
|
| Plan sponsor’s mailing address |
304 FEDERAL ROAD, BROOKFIELD, CT, 06804
|
| Plan sponsor’s
address |
304 FEDERAL ROAD, BROOKFIELD, CT, 06804
|
Plan administrator’s name and address
| Administrator’s EIN |
201899479 |
| Plan administrator’s name |
BROOKFIELD DENTAL ASSOCIATES LLC |
| Plan administrator’s
address |
304 FEDERAL ROAD, BROOKFIELD, CT, 06804 |
Number of participants as of the end of the plan year
| Active participants |
2 |
| Number of
participants
with
account balances as of the end of the plan year |
2 |
Signature of
| Role |
Plan administrator |
| Date |
2010-10-13 |
| Name of individual signing |
RICHARD FISHER |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2010-10-13 |
| Name of individual signing |
RICHARD FISHER |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
BROOKFIELD DENTAL ASSOCIATES LLC 401K PLAN
|
2009
|
201899479
|
2010-10-13
|
BROOKFIELD DENTAL ASSOCIATES LLC
|
2
|
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2004-11-01
|
| Business code |
621210
|
| Plan sponsor’s mailing address |
304 FEDERAL ROAD, BROOKFIELD, CT, 06804
|
| Plan sponsor’s
address |
304 FEDERAL ROAD, BROOKFIELD, CT, 06804
|
Plan administrator’s name and address
| Administrator’s EIN |
201899479 |
| Plan administrator’s name |
BROOKFIELD DENTAL ASSOCIATES LLC |
| Plan administrator’s
address |
304 FEDERAL ROAD, BROOKFIELD, CT, 06804 |
Number of participants as of the end of the plan year
| Active participants |
2 |
| Number of
participants
with
account balances as of the end of the plan year |
2 |
Signature of
| Role |
Plan administrator |
| Date |
2010-10-13 |
| Name of individual signing |
RICHARD FISHER |
| Valid signature |
Filed with incorrect/unrecognized electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2010-10-13 |
| Name of individual signing |
RICHARD FISHER |
| Valid signature |
Filed with incorrect/unrecognized electronic signature |
|
|
|
BROOKFIELD DENTAL ASSOCIATES LLC 401K PLAN
|
2009
|
201899479
|
2010-10-13
|
BROOKFIELD DENTAL ASSOCIATES LLC
|
2
|
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2004-11-01
|
| Business code |
621210
|
| Plan sponsor’s mailing address |
304 FEDERAL ROAD, BROOKFIELD, CT, 06804
|
| Plan sponsor’s
address |
304 FEDERAL ROAD, BROOKFIELD, CT, 06804
|
Plan administrator’s name and address
| Administrator’s EIN |
201899479 |
| Plan administrator’s name |
BROOKFIELD DENTAL ASSOCIATES LLC |
| Plan administrator’s
address |
304 FEDERAL ROAD, BROOKFIELD, CT, 06804 |
Number of participants as of the end of the plan year
| Active participants |
2 |
| Number of
participants
with
account balances as of the end of the plan year |
2 |
Signature of
| Role |
Plan administrator |
| Date |
2010-10-13 |
| Name of individual signing |
RICHARD FISHER |
| Valid signature |
Filed with incorrect/unrecognized electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2010-10-13 |
| Name of individual signing |
RICHARD FISHER |
| Valid signature |
Filed with incorrect/unrecognized electronic signature |
|
|
