NORTHWEST DERMATOLOGY, S.C. P.S & SAVINGS PLAN & TRUST
|
2012
|
363576064
|
2013-07-17
|
NORTHWEST DERMATOLOGY, S.C.
|
23
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1986-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8478848096
|
Plan sponsor’s
address |
2500 WEST HIGGINS ROAD, SUITE 1040, HOFFMAN ESTATES, IL, 60169
|
Signature of
Role |
Plan administrator |
Date |
2013-07-17 |
Name of individual signing |
SUSAN LIEBOVITZ |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-07-17 |
Name of individual signing |
SUSAN LIEBOVITZ |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
NORTHWEST DERMATOLOGY, S.C. P.S & SAVINGS PLAN & TRUST
|
2011
|
363576064
|
2012-07-15
|
NORTHWEST DERMATOLOGY, S.C.
|
23
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1986-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8478848096
|
Plan sponsor’s
address |
2500 WEST HIGGINS ROAD, SUITE 1040, HOFFMAN ESTATES, IL, 60169
|
Plan administrator’s name and address
Administrator’s EIN |
363576064 |
Plan administrator’s name |
NORTHWEST DERMATOLOGY, S.C. |
Plan administrator’s
address |
2500 WEST HIGGINS ROAD, SUITE 1040, HOFFMAN ESTATES, IL, 60169 |
Administrator’s telephone number |
8478848096 |
Signature of
Role |
Plan administrator |
Date |
2012-07-15 |
Name of individual signing |
SUSAN LIEBOVITZ |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2012-07-15 |
Name of individual signing |
SUSAN LIEBOVITZ |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
NORTHWEST DERMATOLOGY, S.C. P.S & SAVINGS PLAN & TRUST
|
2010
|
363576064
|
2011-05-07
|
NORTHWEST DERMATOLOGY, S.C.
|
26
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1986-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8478848096
|
Plan sponsor’s
address |
2500 WEST HIGGINS ROAD, SUITE 1040, HOFFMAN ES, IL, 60169
|
Plan administrator’s name and address
Administrator’s EIN |
363576064 |
Plan administrator’s name |
NORTHWEST DERMATOLOGY, S.C. |
Plan administrator’s
address |
2500 WEST HIGGINS ROAD, SUITE 1040, HOFFMAN ES, IL, 60169 |
Administrator’s telephone number |
8478848096 |
Signature of
Role |
Plan administrator |
Date |
2011-05-07 |
Name of individual signing |
SUSAN LIEBOVITZ,MD |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2011-05-07 |
Name of individual signing |
SUSAN LIEBOVITZ,MD |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
NORTHWEST DERMATOLOGY, S.C. P.S & SAVINGS PLAN & TRUST
|
2009
|
363576064
|
2010-07-14
|
NORTHWEST DERMATOLOGY, S.C.
|
19
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1986-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8478848096
|
Plan sponsor’s
address |
2500 WEST HIGGINS ROAD, SUITE 1040, HOFFMAN ESTATES, IL, 60169
|
Plan administrator’s name and address
Administrator’s EIN |
363576064 |
Plan administrator’s name |
NORTHWEST DERMATOLOGY, S.C. |
Plan administrator’s
address |
2500 WEST HIGGINS ROAD, SUITE 1040, HOFFMAN ESTATES, IL, 60169 |
Administrator’s telephone number |
8478848096 |
Signature of
Role |
Plan administrator |
Date |
2010-07-14 |
Name of individual signing |
SUSAN LIEBOVITZ |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2010-07-14 |
Name of individual signing |
SUSAN LIEBOVITZ |
Valid signature |
Filed with authorized/valid electronic signature |
|
|