|
UNION PEDIATRIC DENTISTRY, PLLC 401(K) PROFIT SHARING PLAN
|
2023
|
770704766
|
2024-08-19
|
UNION PEDIATRIC DENTISTRY, PLLC
|
28
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2015-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
8593846050
|
| Plan sponsor’s
address |
2012 CALLIE WAY, SUITE 202, UNION, KY, 41091
|
Signature of
| Role |
Plan administrator |
| Date |
2024-08-19 |
| Name of individual signing |
JEREMY J. SCHIRA |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
UNION PEDIATRIC DENTISTRY, PLLC 401(K) PROFIT SHARING PLAN
|
2022
|
770704766
|
2023-10-12
|
UNION PEDIATRIC DENTISTRY, PLLC
|
35
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2015-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
8593846050
|
| Plan sponsor’s
address |
2012 CALLIE WAY, SUITE 202, UNION, KY, 41091
|
Signature of
| Role |
Plan administrator |
| Date |
2023-10-12 |
| Name of individual signing |
JEREMY J. SCHIRA |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
UNION PEDIATRIC DENTISTRY CBS BENEFIT PLAN
|
2021
|
770704766
|
2022-12-29
|
UNION PEDIATRIC DENTISTRY
|
8
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2020-08-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
8593846050
|
| Plan sponsor’s
address |
2012 CALLIE WAY, STE 202, UNION, KY, 41091
|
Plan administrator’s name and address
| Administrator’s EIN |
846429706 |
| Plan administrator’s name |
SHAWNA BURTON |
| Plan administrator’s
address |
464 CHENAULT RD, FRANKFORT, KY, 40601 |
| Administrator’s telephone number |
5026954700 |
Signature of
| Role |
Plan administrator |
| Date |
2022-12-29 |
| Name of individual signing |
SHAWNA BURTON |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
UNION PEDIATRIC DENTISTRY, PLLC 401(K) PROFIT SHARING PLAN
|
2021
|
770704766
|
2022-08-31
|
UNION PEDIATRIC DENTISTRY, PLLC
|
32
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2015-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
8593846050
|
| Plan sponsor’s
address |
2012 CALLIE WAY, SUITE 202, UNION, KY, 41091
|
|
|
UNION PEDIATRIC DENTISTRY CBS BENEFIT PLAN
|
2020
|
770704766
|
2021-12-14
|
UNION PEDIATRIC DENTISTRY
|
8
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2020-08-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
8593846050
|
| Plan sponsor’s
address |
2012 CALLIE WAY, STE 202, UNION, KY, 41091
|
Plan administrator’s name and address
| Administrator’s EIN |
846429706 |
| Plan administrator’s name |
SHAWNA BURTON |
| Plan administrator’s
address |
464 CHENAULT RD, FRANKFORT, KY, 40601 |
| Administrator’s telephone number |
5026954700 |
Signature of
| Role |
Plan administrator |
| Date |
2021-12-14 |
| Name of individual signing |
SHAWNA BURTON |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
