|
SCOTT KOLPON, DDS P.C. 401(K) PLAN AND TRUST
|
2011
|
743068862
|
2012-05-11
|
SCOTT KOLPON, DDS P.C.
|
3
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2003-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
7187432264
|
| Plan sponsor’s
address |
2611 EAST 13TH STREET, BROOKLYN, NY, 11235
|
Plan administrator’s name and address
| Administrator’s EIN |
743068862 |
| Plan administrator’s name |
SCOTT KOLPON, DDS P.C. |
| Plan administrator’s
address |
2611 EAST 13TH STREET, BROOKLYN, NY, 11235 |
| Administrator’s telephone number |
7187432264 |
Signature of
| Role |
Plan administrator |
| Date |
2012-05-11 |
| Name of individual signing |
SCOTT KOLPON |
|
| Role |
Employer/plan sponsor |
| Date |
2012-05-11 |
| Name of individual signing |
SCOTT KOLPON |
|
|
|
SCOTT KOLPON, DDS P.C. 401(K) PLAN AND TRUST
|
2010
|
743068862
|
2011-06-10
|
SCOTT KOLPON, DDS P.C.
|
2
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2003-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
7187432264
|
| Plan sponsor’s
address |
2611 EAST 13TH STREET, BROOKLYN, NY, 11235
|
Plan administrator’s name and address
| Administrator’s EIN |
743068862 |
| Plan administrator’s name |
SCOTT KOLPON, DDS P.C. |
| Plan administrator’s
address |
2611 EAST 13TH STREET, BROOKLYN, NY, 11235 |
| Administrator’s telephone number |
7187432264 |
Signature of
| Role |
Plan administrator |
| Date |
2011-06-10 |
| Name of individual signing |
SCOTT KOLPON |
|
| Role |
Employer/plan sponsor |
| Date |
2011-06-10 |
| Name of individual signing |
SCOTT KOLPON |
|
|
|
SCOTT KOLPON, DDS P.C. 401(K) PLAN AND TRUST
|
2009
|
743068862
|
2010-08-20
|
SCOTT KOLPON, DDS P.C.
|
2
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2003-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
7187432264
|
| Plan sponsor’s mailing address |
2611 EAST 13TH STREET, BROOKLYN, NY, 11235
|
| Plan sponsor’s
address |
SCOTT M. KOLPON, DDS P.C., 2611 EAST 13TH STREET, BROOKLYN, NY, 11235
|
Plan administrator’s name and address
| Administrator’s EIN |
743068862 |
| Plan administrator’s name |
SCOTT KOLPON, DDS P.C. |
| Plan administrator’s
address |
2611 EAST 13TH STREET, BROOKLYN, NY, 11235 |
| Administrator’s telephone number |
7187432264 |
Number of participants as of the end of the plan year
| Active participants |
2 |
| Retired or separated participants receiving
benefits |
0 |
| Other
retired or separated participants entitled to future benefits |
0 |
| Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
| Number of
participants
with
account balances as of the end of the plan year |
2 |
| Number of participants that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
0 |
Signature of
| Role |
Plan administrator |
| Date |
2010-08-20 |
| Name of individual signing |
SCOTT KOLPON |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2010-08-20 |
| Name of individual signing |
SCOTT KOLPON |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
