|
PETER SIROKA, D.P.M., P.C. PROFIT SHARING PLAN
|
2013
|
112930788
|
2014-07-29
|
PETER SIROKA, D.P.M., P.C.
|
3
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
003
|
| Effective date of plan |
2002-01-01
|
| Business code |
621391
|
| Sponsor’s telephone number |
2032274837
|
| Plan sponsor’s mailing address |
39 GORHAM AVENUE, WESTPORT, CT, 06880
|
| Plan sponsor’s
address |
39 GORHAM AVENUE, WESTPORT, CT, 06880
|
Number of participants as of the end of the plan year
| Active participants |
3 |
| 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 |
3 |
| 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 |
2014-07-28 |
| Name of individual signing |
PETER SIROKA |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2014-07-28 |
| Name of individual signing |
PETER SIROKA |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
PETER SIROKA, D.P.M., P.C. PROFIT SHARING PLAN
|
2012
|
112930788
|
2013-10-11
|
PETER SIROKA, D.P.M., P.C.
|
4
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
003
|
| Effective date of plan |
2002-01-01
|
| Business code |
621391
|
| Sponsor’s telephone number |
2032274837
|
| Plan sponsor’s mailing address |
39 GORHAM AVENUE, WESTPORT, CT, 06880
|
| Plan sponsor’s
address |
39 GORHAM AVENUE, WESTPORT, CT, 06880
|
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 |
2013-09-03 |
| Name of individual signing |
PETER SIROKA |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
PETER SIROKA, D.P.M., P.C. PROFIT SHARING PLAN
|
2011
|
112930788
|
2012-10-05
|
PETER SIROKA, D.P.M., P.C.
|
3
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
003
|
| Effective date of plan |
2002-01-01
|
| Business code |
621391
|
| Sponsor’s telephone number |
2032274837
|
| Plan sponsor’s mailing address |
39 GORHAM AVENUE, WESTPORT, CT, 06880
|
| Plan sponsor’s
address |
39 GORHAM AVENUE, WESTPORT, CT, 06880
|
Plan administrator’s name and address
| Administrator’s EIN |
112930788 |
| Plan administrator’s name |
PETER SIROKA, D.P.M., P.C. |
| Plan administrator’s
address |
39 GORHAM AVENUE, WESTPORT, CT, 06880 |
| Administrator’s telephone number |
2032274837 |
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 |
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 |
3 |
| Number of participants that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
1 |
Signature of
| Role |
Plan administrator |
| Date |
2012-08-19 |
| Name of individual signing |
PETER SIROKA |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
PETER SIROKA, D.P.M., P.C. PROFIT SHARING PLAN
|
2010
|
112930788
|
2011-09-07
|
PETER SIROKA, D.P.M., P.C.
|
3
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
003
|
| Effective date of plan |
2002-01-01
|
| Business code |
621391
|
| Sponsor’s telephone number |
2032274837
|
| Plan sponsor’s mailing address |
39 GORHAM AVENUE, WESTPORT, CT, 06880
|
| Plan sponsor’s
address |
39 GORHAM AVENUE, WESTPORT, CT, 06880
|
Plan administrator’s name and address
| Administrator’s EIN |
112930788 |
| Plan administrator’s name |
PETER SIROKA, D.P.M., P.C. |
| Plan administrator’s
address |
39 GORHAM AVENUE, WESTPORT, CT, 06880 |
| Administrator’s telephone number |
2032274837 |
Number of participants as of the end of the plan year
| Active participants |
3 |
| 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 |
3 |
| 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 |
2011-09-01 |
| Name of individual signing |
PETER SIROKA |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
PETER SIROKA, D.P.M., P.C. PROFIT SHARING PLAN
|
2009
|
112930788
|
2010-09-14
|
PETER SIROKA, D.P.M., P.C.
|
4
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
003
|
| Effective date of plan |
2002-01-01
|
| Business code |
621391
|
| Sponsor’s telephone number |
2032274837
|
| Plan sponsor’s mailing address |
39 GORHAM AVENUE, WESTPORT, CT, 06880
|
| Plan sponsor’s
address |
39 GORHAM AVENUE, WESTPORT, CT, 06880
|
Plan administrator’s name and address
| Administrator’s EIN |
112930788 |
| Plan administrator’s name |
PETER SIROKA, D.P.M., P.C. |
| Plan administrator’s
address |
39 GORHAM AVENUE, WESTPORT, CT, 06880 |
| Administrator’s telephone number |
2032274837 |
Number of participants as of the end of the plan year
| Active participants |
3 |
| 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 |
3 |
| 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 |
2010-09-13 |
| Name of individual signing |
PETER SIROKA |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
