|
BRENT WORTHAM DMD, PLLC 401(K) PLAN
|
2015
|
204507044
|
2016-10-06
|
BRENT WORTHAM DMD, PLLC
|
3
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
002
|
| Effective date of plan |
2012-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2702173611
|
| Plan sponsor’s
address |
765 CROWELL RD, SYMSONIA, KY, 42082
|
|
|
BRENT WORTHAM DMD, PLLC 401(K) PLAN
|
2014
|
204507044
|
2015-10-15
|
BRENT WORTHAM DMD, PLLC
|
4
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
002
|
| Effective date of plan |
2012-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2702173611
|
| Plan sponsor’s
address |
765 CROWELL RD, SYMSONIA, KY, 42082
|
|
|
BRENT WORTHAM DMD, PLLC 401(K) PLAN
|
2013
|
204507044
|
2014-10-13
|
BRENT WORTHAM DMD, PLLC
|
3
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
002
|
| Effective date of plan |
2012-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2702173611
|
| Plan sponsor’s
address |
765 CROWELL RD, SYMSONIA, KY, 42082
|
|
|
BRENT WORTHAM DMD, PLLC 401(K) PLAN
|
2012
|
204507044
|
2013-07-25
|
BRENT WORTHAM DMD, PLLC
|
3
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
002
|
| Effective date of plan |
2012-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2702173611
|
| Plan sponsor’s
address |
765 CROWELL RD, SYMSONIA, KY, 42082
|
Signature of
| Role |
Plan administrator |
| Date |
2013-07-25 |
| Name of individual signing |
KATHY KEATON |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
BRENT WORTHAM, DMD, PC DEFINED BENEFIT PLAN
|
2011
|
204507044
|
2012-05-16
|
BRENT WORTHAM, DMD, PLLC
|
8
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2004-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2704447645
|
| Plan sponsor’s
address |
408 SOUTH, 28TH STREET, SUITE A, PADUCAH, KY, 42003
|
Plan administrator’s name and address
| Administrator’s EIN |
204507044 |
| Plan administrator’s name |
BRENT WORTHAM, DMD, PLLC |
| Plan administrator’s
address |
408 SOUTH, 28TH STREET, SUITE A, PADUCAH, KY, 42003 |
| Administrator’s telephone number |
2704447645 |
Signature of
| Role |
Plan administrator |
| Date |
2012-05-16 |
| Name of individual signing |
BRENT WORTHAM, DMD |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2012-05-16 |
| Name of individual signing |
BRENT WORTHAM, DMD |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
BRENT WORTHAM, DMD, PC DEFINED BENEFIT PLAN
|
2010
|
204507044
|
2011-07-28
|
BRENT WORTHAM, DMD, PLLC
|
5
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2004-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2704447645
|
| Plan sponsor’s
address |
408 SOUTH, 28TH STREET, SUITE A, PADUCAH, KY, 42003
|
Plan administrator’s name and address
| Administrator’s EIN |
204507044 |
| Plan administrator’s name |
BRENT WORTHAM, DMD, PLLC |
| Plan administrator’s
address |
408 SOUTH, 28TH STREET, SUITE A, PADUCAH, KY, 42003 |
| Administrator’s telephone number |
2704447645 |
Signature of
| Role |
Plan administrator |
| Date |
2011-07-28 |
| Name of individual signing |
BRENT WORTHAM, DMD |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2011-07-28 |
| Name of individual signing |
BRENT WORTHAM, DMD |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
