|
LIGHTHOUSE DENTAL GROUP 401K PLAN
|
2023
|
271467916
|
2024-10-15
|
LIGHTHOUSE DENTAL GROUP PLLC
|
57
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2010-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2089393010
|
| Plan sponsor’s
address |
1177 N EAGLE RD, EAGLE, ID, 83616
|
Signature of
| Role |
Plan administrator |
| Date |
2024-10-15 |
| Name of individual signing |
BRIAN JENSEN |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
LIGHTHOUSE DENTAL GROUP 401K PLAN
|
2023
|
271467916
|
2024-10-15
|
LIGHTHOUSE DENTAL GROUP PLLC
|
57
|
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2010-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2089393010
|
| Plan sponsor’s
address |
1177 N EAGLE RD, EAGLE, ID, 83616
|
Signature of
| Role |
Plan administrator |
| Date |
2024-10-15 |
| Name of individual signing |
BRIAN JENSEN |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
LIGHTHOUSE DENTAL GROUP 401K PLAN
|
2022
|
271467916
|
2023-07-20
|
LIGHTHOUSE DENTAL GROUP PLLC
|
38
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2010-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2089393010
|
| Plan sponsor’s
address |
1177 N EAGLE RD, EAGLE, ID, 83616
|
Signature of
| Role |
Plan administrator |
| Date |
2023-07-20 |
| Name of individual signing |
MICHAEL HIGGINSON |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
LIGHTHOUSE DENTAL GROUP 401K PLAN
|
2021
|
271467916
|
2022-10-12
|
LIGHTHOUSE DENTAL GROUP PLLC
|
27
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2010-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2089393010
|
| Plan sponsor’s
address |
1177 N EAGLE RD, EAGLE, ID, 83616
|
Signature of
| Role |
Plan administrator |
| Date |
2022-10-12 |
| Name of individual signing |
MICHAEL HIGGINSON |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
LIGHTHOUSE DENTAL GROUP 401K PLAN
|
2020
|
271467916
|
2022-10-14
|
LIGHTHOUSE DENTAL GROUP PLLC
|
23
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2010-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2089393010
|
| Plan sponsor’s
address |
1177 N EAGLE RD, EAGLE, ID, 83616
|
Signature of
| Role |
Plan administrator |
| Date |
2022-10-14 |
| Name of individual signing |
MICHAEL HIGGINSON |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
LIGHTHOUSE DENTAL GROUP 401K PLAN
|
2020
|
271467916
|
2021-10-13
|
LIGHTHOUSE DENTAL GROUP PLLC
|
23
|
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2010-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2089393010
|
| Plan sponsor’s
address |
1177 N EAGLE RD, EAGLE, ID, 83616
|
Signature of
| Role |
Plan administrator |
| Date |
2021-10-13 |
| Name of individual signing |
MICHAEL HIGGINSON |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
LIGHTHOUSE DENTAL GROUP 401(K) PLAN
|
2019
|
271467916
|
2020-10-15
|
LIGHTHOUSE DENTAL GROUP, PLLC
|
22
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2010-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2089393010
|
| Plan sponsor’s
address |
1177 N. EAGLE RD., EAGLE, ID, 83616
|
|
|
LIGHTHOUSE DENTAL GROUP 401(K) PLAN
|
2018
|
271467916
|
2019-10-10
|
LIGHTHOUSE DENTAL GROUP, PLLC
|
24
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2010-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2089393010
|
| Plan sponsor’s
address |
1177 N. EAGLE RD., EAGLE, ID, 83616
|
|
|
LIGHTHOUSE DENTAL GROUP 401(K) PLAN
|
2017
|
271467916
|
2018-08-30
|
LIGHTHOUSE DENTAL GROUP, PLLC
|
23
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2010-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2089393010
|
| Plan sponsor’s
address |
1177 N. EAGLE RD., EAGLE, ID, 83616
|
|
|
LIGHTHOUSE DENTAL GROUP 401(K) PLAN
|
2016
|
271467916
|
2017-10-10
|
LIGHTHOUSE DENTAL GROUP, PLLC
|
21
|
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2010-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2089393010
|
| Plan sponsor’s
address |
1177 N. EAGLE RD., EAGLE, ID, 83616
|
|
