|
BROOKDALE DENTAL, P.A. 401(K) PLAN
|
2023
|
820498494
|
2024-10-02
|
BROOKDALE DENTAL, P.A.
|
6
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2020-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2083730018
|
| Plan sponsor’s
address |
13219 W. PERSIMMON LANE, BOISE, ID, 83713
|
Signature of
| Role |
Plan administrator |
| Date |
2024-10-02 |
| Name of individual signing |
ROBERT BARNEY |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
BROOKDALE DENTAL, P.A. 401(K) PLAN
|
2022
|
820498494
|
2024-10-17
|
BROOKDALE DENTAL, P.A.
|
9
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2020-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2083730018
|
| Plan sponsor’s
address |
13219 W. PERSIMMON LANE, BOISE, ID, 83713
|
Signature of
| Role |
Plan administrator |
| Date |
2024-10-17 |
| Name of individual signing |
ROBERT BARNEY |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
BROOKDALE DENTAL, P.A. 401(K) PLAN
|
2022
|
820498494
|
2023-10-10
|
BROOKDALE DENTAL, P.A.
|
9
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2020-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2083730018
|
| Plan sponsor’s
address |
13219 W. PERSIMMON LANE, BOISE, ID, 83713
|
Signature of
| Role |
Plan administrator |
| Date |
2023-10-10 |
| Name of individual signing |
ROBERT BARNEY |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
BROOKDALE DENTAL, P.A. 401(K) PLAN
|
2021
|
820498494
|
2022-10-12
|
BROOKDALE DENTAL, P.A.
|
7
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2020-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2083730018
|
| Plan sponsor’s
address |
13219 W. PERSIMMON LANE, BOISE, ID, 83713
|
Signature of
| Role |
Plan administrator |
| Date |
2022-10-12 |
| Name of individual signing |
ROBERT BARNEY |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
BROOKDALE DENTAL, P.A. 401 (K) PLAN
|
2020
|
820498494
|
2021-10-09
|
BROOKDALE DENTAL, P.A.
|
8
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2020-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2083730018
|
| Plan sponsor’s
address |
13219 W PERSIMMON LN, BOISE, ID, 837131986
|
Signature of
| Role |
Plan administrator |
| Date |
2021-10-09 |
| Name of individual signing |
ROBERT BARNEY |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2021-10-09 |
| Name of individual signing |
ROBERT BARNEY |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
BROOKDALE DENTAL, P.A. 401(K) PLAN
|
2020
|
820498494
|
2021-10-12
|
BROOKDALE DENTAL, P.A.
|
8
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2020-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2083730018
|
| Plan sponsor’s
address |
13219 W. PERSIMMON LANE, BOISE, ID, 83713
|
Signature of
| Role |
Plan administrator |
| Date |
2021-10-12 |
| Name of individual signing |
ROBERT BARNEY |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
