DR. SRIVASTAVA, S. C.

Company Details

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

DRS SRIVASTAVA, S.C. PROFIT SHARING PLAN

2017

363146949

2018-07-05

DRS SRIVASTAVA, S.C.

Signature of

Role	Plan administrator
Date	2018-07-05
Name of individual signing	JOHN HAMILL
Valid signature	Filed with authorized/valid electronic signature

Role	Employer/plan sponsor
Date	2018-07-05
Name of individual signing	JOHN HAMILL
Valid signature	Filed with authorized/valid electronic signature

DRS SRIVASTAVA, .S.C. PROFIT SHARING PLAN

2016

363146949

2017-07-24

DRS SRIVASTAVA, S.C.

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	1985-01-01
Business code	621111
Sponsor’s telephone number	8152261906
Plan sponsor’s mailing address	4920 E STATE STREET, ROCKFORD, IL, 61108
Plan sponsor’s address	4920 E STATE STREET, ROCKFORD, IL, 61108

Plan administrator’s name and address

Administrator’s EIN	363146949
Plan administrator’s name	MADHAV K SRIVASTAVA, M.D.
Plan administrator’s address	4920 E STATE STREET, ROCKFORD, IL, 61108
Administrator’s telephone number	8152261906

Number of participants as of the end of the plan year

Active participants	4
Retired or separated participants receiving benefits	1
Number of participants with account balances as of the end of the plan year	4
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	2017-07-11
Name of individual signing	MADHAV K SRIVASTAVA, M.D.
Valid signature	Filed with authorized/valid electronic signature

Role	Employer/plan sponsor
Date	2017-07-11
Name of individual signing	MADHAV K SRIVASTAVA, M.D.
Valid signature	Filed with authorized/valid electronic signature

Role	DFE
Date	2017-07-11
Name of individual signing	JOHN C HAMILL CPA
Valid signature	Filed with authorized/valid electronic signature

Name and Address	Role	Appointment Date
DAVID L DAVITT, 6072 BRYNWOOD DR STE 206, ROCKFORD, 61114, WINNEBAGO	Agent	2022-10-12

Name and Address	Role
MADHAV K. SRIVASTAVA 4920 EAST STATE ST. ROCKFORD,IL 61108	President

Name	Change Date
DRS. SRIVASTAVA, S.C.	1991-04-19

Class	Series	Voting Rights	Authorized Shares	Issued Shares	Par Value
COMM	No data	Voting Rights	100000	1000000	1

Date of last update: 23 Dec 2024