VIJAY M. HARYANI, M.D., S.C. RETIREMENT PLAN AND TRUST
|
2012
|
364113871
|
2013-09-05
|
VIJAY M. HARYANI, M.D., S.C.
|
16
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
2005-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8159363240
|
Plan sponsor’s
address |
3627 TOULOUSE, BOURBONNAIS, IL, 609144552
|
Signature of
Role |
Plan administrator |
Date |
2013-09-05 |
Name of individual signing |
VIJAY M. HARYANI, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
VIJAY M. HARYANI, M.D., S.C. CASH OR DEFERRED PROFIT-SHARING PLAN & TRUST
|
2012
|
364113871
|
2013-06-17
|
VIJAY M. HARYANI, M.D., S.C.
|
18
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2005-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8159363240
|
Plan sponsor’s
address |
375 N. WALL STREET, STE 310, KANKAKEE, IL, 60901
|
Signature of
Role |
Plan administrator |
Date |
2013-06-17 |
Name of individual signing |
VIJAY HARYANI |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
VIJAY M. HARYANI, M.D., S.C. CASH OR DEFERRED PROFIT-SHARING PLAN & TRUST
|
2011
|
364113871
|
2012-08-09
|
VIJAY M. HARYANI, M.D., S.C.
|
17
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2005-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8159363240
|
Plan sponsor’s
address |
375 N. WALL STREET, STE 310, KANKAKEE, IL, 60901
|
Plan administrator’s name and address
Administrator’s EIN |
364113871 |
Plan administrator’s name |
VIJAY M. HARYANI, M.D., S.C. |
Plan administrator’s
address |
375 N. WALL STREET, STE 310, KANKAKEE, IL, 60901 |
Administrator’s telephone number |
8159363240 |
Signature of
Role |
Plan administrator |
Date |
2012-08-08 |
Name of individual signing |
VIJAY HARYANI |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
VIJAY M. HARYANI, M.D., S.C. RETIREMENT PLAN AND TRUST
|
2011
|
364113871
|
2012-04-11
|
VIJAY M. HARYANI, M.D., S.C.
|
17
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
2005-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8159363240
|
Plan sponsor’s
address |
3627 TOULOUSE, BOURBONNAIS, IL, 609144552
|
Plan administrator’s name and address
Administrator’s EIN |
364113871 |
Plan administrator’s name |
VIJAY M. HARYANI, M.D., S.C. |
Plan administrator’s
address |
3627 TOULOUSE, BOURBONNAIS, IL, 609144552 |
Administrator’s telephone number |
8159363240 |
Signature of
Role |
Plan administrator |
Date |
2012-04-11 |
Name of individual signing |
VIJAY M. HARYANI, M.D. |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
VIJAY M. HARYANI, M.D., S.C. CASH OR DEFERRED PROFIT-SHARING PLAN & TRUST
|
2010
|
364113871
|
2011-08-16
|
VIJAY M. HARYANI, M.D., S.C.
|
19
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
2005-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8159363240
|
Plan sponsor’s
address |
375 N. WALL STREET, STE 310, KANKAKEE, IL, 60901
|
Plan administrator’s name and address
Administrator’s EIN |
364113871 |
Plan administrator’s name |
VIJAY M. HARYANI, M.D., S.C. |
Plan administrator’s
address |
375 N. WALL STREET, STE 310, KANKAKEE, IL, 60901 |
Administrator’s telephone number |
8159363240 |
Signature of
Role |
Plan administrator |
Date |
2011-08-16 |
Name of individual signing |
VIJAY HARYANI |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
VIJAY M. HARYANI, M.D., S.C. RETIREMENT PLAN AND TRUST
|
2010
|
364113871
|
2011-07-14
|
VIJAY M. HARYANI, M.D., S.C.
|
17
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
2005-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8159363240
|
Plan sponsor’s
address |
3627 TOULOUSE, BOURBONNAIS, IL, 609144552
|
Plan administrator’s name and address
Administrator’s EIN |
364113871 |
Plan administrator’s name |
VIJAY M. HARYANI, M.D., S.C. |
Plan administrator’s
address |
3627 TOULOUSE, BOURBONNAIS, IL, 609144552 |
Administrator’s telephone number |
8159363240 |
Signature of
Role |
Plan administrator |
Date |
2011-07-14 |
Name of individual signing |
VIJAY M. HARYANI, PRESIDENT |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
VIJAY M. HARYANI, M.D., S.C. CASH OR DEFERRED PROFIT-SHARING PLAN & TRUST
|
2009
|
364113871
|
2010-09-21
|
VIJAY M. HARYANI, M.D., S.C.
|
17
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
2005-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8159363240
|
Plan sponsor’s
address |
375 N. WALL STREET, STE 310, KANKAKEE, IL, 60901
|
Plan administrator’s name and address
Administrator’s EIN |
364113871 |
Plan administrator’s name |
VIJAY M. HARYANI, M.D., S.C. |
Plan administrator’s
address |
375 N. WALL STREET, STE 310, KANKAKEE, IL, 60901 |
Administrator’s telephone number |
8159363240 |
Signature of
Role |
Plan administrator |
Date |
2010-09-21 |
Name of individual signing |
VIJAY HARYANI |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
VIJAY M. HARYANI, M.D., S.C. RETIREMENT PLAN AND TRUST
|
2009
|
364113871
|
2010-09-04
|
VIJAY M. HARYANI, M.D., S.C.
|
17
|
|
File |
View Page
|
Three-digit plan number (PN) |
002
|
Effective date of plan |
2005-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
8159363240
|
Plan sponsor’s
address |
3627 TOULOUSE, BOURBONNAIS, IL, 609144552
|
Plan administrator’s name and address
Administrator’s EIN |
364113871 |
Plan administrator’s name |
VIJAY M. HARYANI, M.D., S.C. |
Plan administrator’s
address |
3627 TOULOUSE, BOURBONNAIS, IL, 609144552 |
Administrator’s telephone number |
8159363240 |
Signature of
Role |
Plan administrator |
Date |
2010-09-03 |
Name of individual signing |
VIJAY M. HARYANI, PRESIDENT |
Valid signature |
Filed with authorized/valid electronic signature |
|
|