|
PEAK FAMILY DENTAL, 401(K) PLAN
|
2012
|
731636971
|
2013-09-17
|
PEAK FAMILY DENTAL, INC.
|
8
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2007-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
9702290099
|
| Plan sponsor’s mailing address |
2021 BATTLECREEK DRIVE, SUITE C, FORT COLLINS, CO, 80528
|
| Plan sponsor’s
address |
2021 BATTLECREEK DRIVE, SUITE C, FORT COLLINS, CO, 80528
|
Plan administrator’s name and address
| Administrator’s EIN |
731636971 |
| Plan administrator’s name |
PEAK FAMILY DENTAL, INC. |
| Plan administrator’s
address |
2021 BATTLECREEK DRIVE, SUITE C, FORT COLLINS, CO, 80528 |
| Administrator’s telephone number |
9702290099 |
Number of participants as of the end of the plan year
| Active participants |
8 |
| 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 |
7 |
| 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 |
2013-09-17 |
| Name of individual signing |
ARLIE BURNHAM |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2013-09-17 |
| Name of individual signing |
ARLIE BURNHAM |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
PEAK FAMILY DENTAL, 401(K) PLAN
|
2011
|
731636971
|
2012-10-12
|
PEAK FAMILY DENTAL, INC.
|
8
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2007-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
9702290099
|
| Plan sponsor’s mailing address |
2021 BATTLECREEK DRIVE, SUITE C, FORT COLLINS, CO, 80528
|
| Plan sponsor’s
address |
2021 BATTLECREEK DRIVE, SUITE C, FORT COLLINS, CO, 80528
|
Plan administrator’s name and address
| Administrator’s EIN |
731636971 |
| Plan administrator’s name |
PEAK FAMILY DENTAL, INC. |
| Plan administrator’s
address |
2021 BATTLECREEK DRIVE, SUITE C, FORT COLLINS, CO, 80528 |
| Administrator’s telephone number |
9702290099 |
Number of participants as of the end of the plan year
| Active participants |
8 |
| 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 |
7 |
| 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 |
2012-10-12 |
| Name of individual signing |
ARLIE BURNHAM |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
PEAK FAMILY DENTAL, 401(K) PLAN
|
2010
|
731636971
|
2011-09-21
|
PEAK FAMILY DENTAL, INC.
|
9
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2007-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
9702290099
|
| Plan sponsor’s mailing address |
2021 BATTLECREEK DRIVE, SUITE C, FORT COLLINS, CO, 80528
|
| Plan sponsor’s
address |
2021 BATTLECREEK DRIVE, SUITE C, FORT COLLINS, CO, 80528
|
Plan administrator’s name and address
| Administrator’s EIN |
731636971 |
| Plan administrator’s name |
PEAK FAMILY DENTAL, INC. |
| Plan administrator’s
address |
2021 BATTLECREEK DRIVE, SUITE C, FORT COLLINS, CO, 80528 |
| Administrator’s telephone number |
9702290099 |
Number of participants as of the end of the plan year
| Active participants |
8 |
| 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 |
7 |
| 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 |
2011-09-21 |
| Name of individual signing |
ARLIE BURNHAM |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
PEAK FAMILY DENTAL, 401(K) PLAN
|
2009
|
731636971
|
2010-10-14
|
PEAK FAMILY DENTAL, INC.
|
7
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2007-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
9702290099
|
| Plan sponsor’s mailing address |
2021 BATTLECREEK DRIVE, SUITE C, FORT COLLINS, CO, 80528
|
| Plan sponsor’s
address |
2021 BATTLECREEK DRIVE, SUITE C, FORT COLLINS, CO, 80528
|
Plan administrator’s name and address
| Administrator’s EIN |
731636971 |
| Plan administrator’s name |
PEAK FAMILY DENTAL, INC. |
| Plan administrator’s
address |
2021 BATTLECREEK DRIVE, SUITE C, FORT COLLINS, CO, 80528 |
| Administrator’s telephone number |
9702290099 |
Number of participants as of the end of the plan year
| Active participants |
12 |
| 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 |
7 |
| 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 |
2010-10-14 |
| Name of individual signing |
ARLIE BURNHAM |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
