MOHAWK GLEN IMAGING, P.C. PROFIT SHARING TRUST
|
2017
|
160989209
|
2019-06-25
|
MOHAWK GLEN IMAGING, P.C.
|
15
|
|
File |
View Page
|
Three-digit plan number (PN) |
003
|
Effective date of plan |
1998-10-01
|
Business code |
621111
|
Sponsor’s telephone number |
3153349729
|
Plan sponsor’s
address |
91 PERMIMETER ROAD, ROME, NY, 13441
|
Signature of
Role |
Plan administrator |
Date |
2019-06-25 |
Name of individual signing |
LAWRENCE BURGREEN, M.D. |
|
|
MOHAWK GLEN IMAGING, P.C. PROFIT SHARING TRUST
|
2016
|
160989209
|
2018-04-18
|
MOHAWK GLEN IMAGING, P.C.
|
15
|
|
File |
View Page
|
Three-digit plan number (PN) |
003
|
Effective date of plan |
1998-10-01
|
Business code |
621111
|
Sponsor’s telephone number |
3153349729
|
Plan sponsor’s
address |
91 PERIMETER ROAD, ROME, NY, 13441
|
Signature of
Role |
Plan administrator |
Date |
2018-04-18 |
Name of individual signing |
LAWRENCE BURGREEN, M.D. |
|
|
MOHAWK GLEN IMAGING, P.C. PROFIT SHARING TRUST
|
2015
|
160989209
|
2017-06-21
|
MOHAWK GLEN IMAGING, P.C.
|
17
|
|
File |
View Page
|
Three-digit plan number (PN) |
003
|
Effective date of plan |
1998-10-01
|
Business code |
621111
|
Sponsor’s telephone number |
3153349729
|
Plan sponsor’s
address |
91 PERIMETER ROAD, ROME, NY, 13441
|
Signature of
Role |
Plan administrator |
Date |
2017-06-21 |
Name of individual signing |
LAWRENCE BURGREEN, M.D. |
|
|
MOHAWK GLEN IMAGING, P.C. PROFIT SHARING TRUST
|
2014
|
160989209
|
2016-06-06
|
MOHAWK GLEN IMAGING, P.C.
|
19
|
|
File |
View Page
|
Three-digit plan number (PN) |
003
|
Effective date of plan |
1998-10-01
|
Business code |
621111
|
Sponsor’s telephone number |
3153349729
|
Plan sponsor’s
address |
91 PERIMETER ROAD, ROME, NY, 13441
|
Signature of
Role |
Plan administrator |
Date |
2016-06-06 |
Name of individual signing |
LAWRENCE BURGREEN, M.D. |
|
|
MOHAWK GLEN IMAGING, P.C. PROFIT SHARING TRUST
|
2013
|
160989209
|
2015-06-11
|
MOHAWK GLEN IMAGING, P.C.
|
18
|
|
File |
View Page
|
Three-digit plan number (PN) |
003
|
Effective date of plan |
1998-10-01
|
Business code |
621111
|
Sponsor’s telephone number |
3153349729
|
Plan sponsor’s
address |
91 PERIMETER ROAD, ROME, NY, 13441
|
Signature of
Role |
Plan administrator |
Date |
2015-06-11 |
Name of individual signing |
LAWRENCE BURGREEN, M.D. |
|
|
MOHAWK GLEN IMAGING, P.C. PROFIT SHARING TRUST
|
2012
|
160989209
|
2014-06-26
|
MOHAWK GLEN IMAGING, P.C.
|
21
|
|
File |
View Page
|
Three-digit plan number (PN) |
003
|
Effective date of plan |
1998-10-01
|
Business code |
621111
|
Sponsor’s telephone number |
3153349729
|
Plan sponsor’s
address |
91 PERIMETER ROAD, ROME, NY, 13441
|
Signature of
Role |
Plan administrator |
Date |
2014-06-26 |
Name of individual signing |
LAWRENCE BURGREEN, M.D. |
|
|
MOHAWK GLEN IMAGING, P.C. PROFIT SHARING TRUST
|
2011
|
160989209
|
2013-05-20
|
MOHAWK GLEN IMAGING, P.C.
|
24
|
|
File |
View Page
|
Three-digit plan number (PN) |
003
|
Effective date of plan |
1998-10-01
|
Business code |
621111
|
Sponsor’s telephone number |
3153349729
|
Plan sponsor’s
address |
91 PERIMETER ROAD, ROME, NY, 13441
|
Plan administrator’s name and address
Administrator’s EIN |
160989209 |
Plan administrator’s name |
MOHAWK GLEN IMAGING, P.C. |
Plan administrator’s
address |
91 PERIMETER ROAD, ROME, NY, 13441 |
Administrator’s telephone number |
3153349729 |
Signature of
Role |
Plan administrator |
Date |
2013-05-20 |
Name of individual signing |
LAWRENCE BURGREEN, M.D. |
|
|
MOHAWK GLEN IMAGING, P.C. PROFIT SHARING TRUST
|
2010
|
160989209
|
2012-05-23
|
MOHAWK GLEN IMAGING, P.C.
|
21
|
|
File |
View Page
|
Three-digit plan number (PN) |
003
|
Effective date of plan |
1998-10-01
|
Business code |
621111
|
Sponsor’s telephone number |
3153349729
|
Plan sponsor’s
address |
91 PERIMETER ROAD, ROME, NY, 13441
|
Plan administrator’s name and address
Administrator’s EIN |
160989209 |
Plan administrator’s name |
MOHAWK GLEN IMAGING, P.C. |
Plan administrator’s
address |
91 PERIMETER ROAD, ROME, NY, 13441 |
Administrator’s telephone number |
3153349729 |
Signature of
Role |
Plan administrator |
Date |
2012-05-23 |
Name of individual signing |
LAWRENCE BURGREEN, M.D. |
|
|
MOHAWK GLEN IMAGING, P.C. PROFIT SHARING TRUST
|
2009
|
160989209
|
2011-06-08
|
MOHAWK GLEN IMAGING, P.C.
|
21
|
|
File |
View Page
|
Three-digit plan number (PN) |
003
|
Effective date of plan |
1998-10-01
|
Business code |
621111
|
Sponsor’s telephone number |
3153349729
|
Plan sponsor’s
address |
91 PERIMETER ROAD, ROME, NY, 13441
|
Plan administrator’s name and address
Administrator’s EIN |
160989209 |
Plan administrator’s name |
MOHAWK GLEN IMAGING, P.C. |
Plan administrator’s
address |
91 PERIMETER ROAD, ROME, NY, 13441 |
Administrator’s telephone number |
3153349729 |
Signature of
Role |
Plan administrator |
Date |
2011-06-08 |
Name of individual signing |
LAWRENCE BURGREEN, M.D. |
|
|