HAWTHORN DENTAL ASSOCIATES, P.C. 401 K PROFIT SHARING PLAN
|
2011
|
363993934
|
2012-07-16
|
HAWTHORN DENTAL ASSOCIATES, P.C.
|
12
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
1999-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8473677222
|
Plan sponsor’s
address |
1220 E. US HWY 45, SUITE 200, VERNON HILLS, IL, 60061
|
Plan administrator’s name and address
Administrator’s EIN |
363993934 |
Plan administrator’s name |
HAWTHORN DENTAL ASSOCIATES, P.C. |
Plan administrator’s
address |
1220 E. US HWY 45, SUITE 200, VERNON HILLS, IL, 60061 |
Administrator’s telephone number |
8473677222 |
Signature of
Role |
Plan administrator |
Date |
2012-07-16 |
Name of individual signing |
DR. MICHAEL MORA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2012-07-16 |
Name of individual signing |
DR. MICHAEL MORA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
HAWTHORN DENTAL ASSOCIATES, P.C. 401K PROFIT SHARING PLAN
|
2010
|
363993934
|
2011-10-06
|
HAWTHORN DENTAL ASSOCIATES, P.C.
|
12
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
1999-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8473677222
|
Plan sponsor’s
address |
1220 E. US HIGHWAY 45, SUITE 200, VERNON HILLS, IL, 60061
|
Plan administrator’s name and address
Administrator’s EIN |
363993934 |
Plan administrator’s name |
HAWTHORN DENTAL ASSOCIATES, P.C. |
Plan administrator’s
address |
1220 E. US HIGHWAY 45, SUITE 200, VERNON HILLS, IL, 60061 |
Administrator’s telephone number |
8473677222 |
Signature of
Role |
Plan administrator |
Date |
2011-10-06 |
Name of individual signing |
MICHAEL MORA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2011-10-06 |
Name of individual signing |
MICHAEL MORA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
HAWTHORN DENTAL ASSOCIATES, P.C. 401K PROFIT SHARING PLAN
|
2009
|
363993934
|
2010-10-14
|
HAWTHORN DENTAL ASSOCIATES, P.C.
|
11
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
1999-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8473677222
|
Plan sponsor’s
address |
888 CREEK BEND, VERNON HILLS, IL, 60061
|
Plan administrator’s name and address
Administrator’s EIN |
363993934 |
Plan administrator’s name |
HAWTHORN DENTAL ASSOCIATES, P.C. |
Plan administrator’s
address |
888 CREEK BEND, VERNON HILLS, IL, 60061 |
Administrator’s telephone number |
8473677222 |
Signature of
Role |
Plan administrator |
Date |
2010-10-13 |
Name of individual signing |
MICHAEL MORA |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2010-10-13 |
Name of individual signing |
MICHAEL MORA |
Valid signature |
Filed with authorized/valid electronic signature |
|
|