JAMES J. GOMEZ, M.D., S.C. EMPLOYEE BENEFIT PLAN & TRUST
|
2012
|
364372627
|
2013-10-10
|
JAMES J. GOMEZ, M.D., S.C.
|
3
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2001-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
7084530866
|
Plan sponsor’s
address |
675 W. NORTH AVENUE, MELROSE PARK, IL, 60160
|
Plan administrator’s name and address
Administrator’s EIN |
364372627 |
Plan administrator’s name |
JAMES J. GOMEZ, M.D., S.C. |
Plan administrator’s
address |
675 W. NORTH AVENUE, MELROSE PARK, IL, 60160 |
Administrator’s telephone number |
7084530866 |
Signature of
Role |
Plan administrator |
Date |
2013-10-09 |
Name of individual signing |
JAMES GOMEZ |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
JAMES J. GOMEZ, M.D., S.C. EMPLOYEE BENEFIT PLAN & TRUST
|
2011
|
364372627
|
2012-07-31
|
JAMES J. GOMEZ, M.D., S.C.
|
3
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2001-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
7084530866
|
Plan sponsor’s
address |
675 W. NORTH AVENUE, MELROSE PARK, IL, 60160
|
Plan administrator’s name and address
Administrator’s EIN |
364372627 |
Plan administrator’s name |
JAMES J. GOMEZ, M.D., S.C. |
Plan administrator’s
address |
675 W. NORTH AVENUE, MELROSE PARK, IL, 60160 |
Administrator’s telephone number |
7084530866 |
Signature of
Role |
Plan administrator |
Date |
2012-07-30 |
Name of individual signing |
JAMES GOMEZ |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
JAMES J. GOMEZ, M.D., S.C. EMPLOYEE BENEFIT PLAN & TRUST
|
2010
|
364372627
|
2011-07-31
|
JAMES J. GOMEZ, M.D., S.C.
|
3
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2001-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
7084530866
|
Plan sponsor’s
address |
675 W. NORTH AVENUE, MELROSE PARK, IL, 60160
|
Plan administrator’s name and address
Administrator’s EIN |
364372627 |
Plan administrator’s name |
JAMES J. GOMEZ, M.D., S.C. |
Plan administrator’s
address |
675 W. NORTH AVENUE, MELROSE PARK, IL, 60160 |
Administrator’s telephone number |
7084530866 |
Signature of
Role |
Plan administrator |
Date |
2011-07-30 |
Name of individual signing |
JAMES GOMEZ |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
JAMES J. GOMEZ, M.D., S.C. EMPLOYEE BENEFIT PLAN & TRUST
|
2009
|
364372627
|
2010-07-28
|
JAMES J. GOMEZ, M.D., S.C.
|
3
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2001-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
7084530866
|
Plan sponsor’s
address |
675 W. NORTH AVENUE, MELROSE PARK, IL, 60160
|
Plan administrator’s name and address
Administrator’s EIN |
364372627 |
Plan administrator’s name |
JAMES J. GOMEZ, M.D., S.C. |
Plan administrator’s
address |
675 W. NORTH AVENUE, MELROSE PARK, IL, 60160 |
Administrator’s telephone number |
7084530866 |
Signature of
Role |
Plan administrator |
Date |
2010-07-27 |
Name of individual signing |
JAMES GOMEZ |
Valid signature |
Filed with authorized/valid electronic signature |
|
|