RESPIRATORY DISEASE CLINIC 401(K) PLAN
|
2015
|
611004800
|
2016-06-16
|
WILLIAM H. CULBERTSON, M.D., P.S.C.
|
17
|
|
File |
View Page
|
Three-digit plan number (PN) |
004
|
Effective date of plan |
2003-01-01
|
Business code |
621112
|
Sponsor’s telephone number |
2704423647
|
Plan sponsor’s
address |
1920 BROADWAY, PADUCAH, KY, 42001
|
Signature of
Role |
Plan administrator |
Date |
2016-06-16 |
Name of individual signing |
KEITH KELLY |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
RESPIRATORY DISEASE CLINIC 401(K) PLAN
|
2014
|
611004800
|
2015-06-10
|
WILLIAM H. CULBERTSON, M.D., P.S.C.
|
18
|
|
File |
View Page
|
Three-digit plan number (PN) |
004
|
Effective date of plan |
2003-01-01
|
Business code |
621112
|
Sponsor’s telephone number |
2704423647
|
Plan sponsor’s
address |
1920 BROADWAY, PADUCAH, KY, 42001
|
Signature of
Role |
Plan administrator |
Date |
2015-06-10 |
Name of individual signing |
WILLIAM H. CULBERTSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2015-06-10 |
Name of individual signing |
WILLIAM H. CULBERTSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
RESPIRATORY DISEASE CLINIC 401(K) PLAN
|
2013
|
611004800
|
2014-09-23
|
WILLIAM H. CULBERTSON, M.D., P.S.C.
|
18
|
|
File |
View Page
|
Three-digit plan number (PN) |
004
|
Effective date of plan |
2003-01-01
|
Business code |
621112
|
Sponsor’s telephone number |
2704423647
|
Plan sponsor’s
address |
1920 BROADWAY, PADUCAH, KY, 42001
|
Signature of
Role |
Plan administrator |
Date |
2014-09-23 |
Name of individual signing |
WILLIAM H. CULBERTSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2014-09-23 |
Name of individual signing |
WILLIAM H. CULBERTSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
RESPIRATORY DISEASE CLINIC 401(K) PLAN
|
2012
|
611004800
|
2013-09-25
|
WILLIAM H. CULBERTSON, M.D., P.S.C.
|
17
|
|
File |
View Page
|
Three-digit plan number (PN) |
004
|
Effective date of plan |
2003-01-01
|
Business code |
621112
|
Sponsor’s telephone number |
2704423647
|
Plan sponsor’s
address |
1920 BROADWAY, PADUCAH, KY, 42001
|
Signature of
Role |
Plan administrator |
Date |
2013-09-25 |
Name of individual signing |
WILLIAM H. CULBERTSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-09-25 |
Name of individual signing |
WILLIAM H. CULBERTSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
RESPIRATORY DISEASE CLINIC 401(K) PLAN
|
2011
|
611004800
|
2012-05-22
|
WILLIAM H. CULBERTSON, M.D., P.S.C.
|
17
|
|
File |
View Page
|
Three-digit plan number (PN) |
004
|
Effective date of plan |
2003-01-01
|
Business code |
621112
|
Sponsor’s telephone number |
2704423647
|
Plan sponsor’s
address |
1920 BROADWAY, PADUCAH, KY, 42001
|
Plan administrator’s name and address
Administrator’s EIN |
611004800 |
Plan administrator’s name |
WILLIAM H. CULBERTSON, M.D., P.S.C. |
Plan administrator’s
address |
1920 BROADWAY, PADUCAH, KY, 42001 |
Administrator’s telephone number |
2704423647 |
Signature of
Role |
Plan administrator |
Date |
2012-05-22 |
Name of individual signing |
WILLIAM H. CULBERTSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2012-05-22 |
Name of individual signing |
WILLIAM H. CULBERTSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
RESPIRATORY DISEASE CLINIC 401(K) PLAN
|
2010
|
611004800
|
2011-07-18
|
WILLIAM H. CULBERTSON, M.D., P.S.C.
|
17
|
|
File |
View Page
|
Three-digit plan number (PN) |
004
|
Effective date of plan |
2003-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
2704423647
|
Plan sponsor’s
address |
1920 BROADWAY, PADUCAH, KY, 42001
|
Plan administrator’s name and address
Administrator’s EIN |
611004800 |
Plan administrator’s name |
WILLIAM H. CULBERTSON, M.D., P.S.C. |
Plan administrator’s
address |
1920 BROADWAY, PADUCAH, KY, 42001 |
Administrator’s telephone number |
2704423647 |
Signature of
Role |
Plan administrator |
Date |
2011-07-08 |
Name of individual signing |
WILLIAM CULBERTSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
RESPIRATORY DISEASE CLINIC 401(K) PLAN
|
2009
|
611004800
|
2010-06-03
|
WILLIAM H. CULBERTSON, M.D., P.S.C.
|
17
|
|
File |
View Page
|
Three-digit plan number (PN) |
004
|
Effective date of plan |
2003-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
2704423647
|
Plan sponsor’s
address |
1920 BROADWAY, PADUCAH, KY, 42001
|
Plan administrator’s name and address
Administrator’s EIN |
611004800 |
Plan administrator’s name |
WILLIAM H. CULBERTSON, M.D., P.S.C. |
Plan administrator’s
address |
1920 BROADWAY, PADUCAH, KY, 42001 |
Administrator’s telephone number |
2704423647 |
Signature of
Role |
Plan administrator |
Date |
2010-06-02 |
Name of individual signing |
WILLIAM CULBERTSON |
Valid signature |
Filed with authorized/valid electronic signature |
|
|