|
MICHAEL ZAKULA, JR., D.D.S., P.A. EMPLOYEES' PROFIT SHARING PLAN AND TRUST
|
2012
|
411501695
|
2013-11-19
|
MICHAEL ZAKULA, JR., D.D.S., P.A.
|
9
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
002
|
| Effective date of plan |
1984-11-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2182639140
|
| Plan sponsor’s
address |
333 HIGHLAND DRIVE, HIBBING, MN, 55746
|
Signature of
| Role |
Plan administrator |
| Date |
2013-11-19 |
| Name of individual signing |
LISA ZAKULA |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
MICHAEL ZAKULA, JR., D.D.S., P.A. EMPLOYEES' PROFIT SHARING PLAN AND TRUST
|
2012
|
411501695
|
2013-09-20
|
MICHAEL ZAKULA, JR., D.D.S., P.A.
|
9
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
002
|
| Effective date of plan |
1984-11-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2182639140
|
| Plan sponsor’s
address |
333 HIGHLAND DRIVE, HIBBING, MN, 55746
|
Signature of
| Role |
Plan administrator |
| Date |
2013-09-20 |
| Name of individual signing |
LISA ZAKULA |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
MICHAEL ZAKULA, JR., D.D.S., P.A. EMPLOYEES' PROFIT SHARING PLAN AND TRUST
|
2011
|
411501695
|
2012-11-05
|
MICHAEL ZAKULA, JR., D.D.S., P.A.
|
10
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
002
|
| Effective date of plan |
1984-11-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2182639140
|
| Plan sponsor’s
address |
333 HIGHLAND DRIVE, HIBBING, MN, 55746
|
Plan administrator’s name and address
| Administrator’s EIN |
411501695 |
| Plan administrator’s name |
MICHAEL ZAKULA, JR., D.D.S., P.A. |
| Plan administrator’s
address |
333 HIGHLAND DRIVE, HIBBING, MN, 55746 |
| Administrator’s telephone number |
2182639140 |
Signature of
| Role |
Plan administrator |
| Date |
2012-11-05 |
| Name of individual signing |
LISA ZAKULA |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2012-11-05 |
| Name of individual signing |
LISA ZAKULA |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
MICHAEL ZAKULA JR., D.D.S., P.A. EMPLOYEES PROFIT SHARING PLAN AND TRUST
|
2009
|
411501695
|
2010-12-14
|
MICHAEL ZAKULA JR., D.D.S., P.A.
|
9
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
002
|
| Effective date of plan |
1984-11-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2182639140
|
| Plan sponsor’s mailing address |
333 HIGHLAND DRIVE, HIBBING, MN, 55746
|
| Plan sponsor’s
address |
510 EAST HOWARD STREET, HIBBING, MN, 55746
|
Plan administrator’s name and address
| Administrator’s EIN |
411501695 |
| Plan administrator’s name |
MICHAEL ZAKULA JR., D.D.S., P.A.-LISA ZAKULA |
| Plan administrator’s
address |
333 HIGHLAND DRIVE, HIBBING, MN, 55746 |
| Administrator’s telephone number |
2182639140 |
Number of participants as of the end of the plan year
| Active participants |
9 |
| Retired or separated participants receiving
benefits |
0 |
| Other
retired or separated participants entitled to future benefits |
1 |
| 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 |
5 |
| 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 |
2010-12-14 |
| Name of individual signing |
LISA V ZAKULA |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
