|
KIM D. FJELSTAD, D.P.M., P.A. 401(K) PLAN
|
2014
|
261436120
|
2015-07-07
|
KIM D. FJELSTAD, D.P.M., P.A.
|
3
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2015-01-01
|
| Business code |
621391
|
| Sponsor’s telephone number |
9524352629
|
| Plan sponsor’s
address |
14000 NICOLLET AVE. S., SUITE 306, BURNSVILLE, MN, 55337
|
Signature of
| Role |
Plan administrator |
| Date |
2015-07-07 |
| Name of individual signing |
KIM D. FJELSTAD, D.P.M., P.A. |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
KIM D. FJELSTAD, D.P.M., P.A. 401(K) PLAN
|
2014
|
261436120
|
2015-07-06
|
KIM D. FJELSTAD, D.P.M., P.A.
|
3
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2011-01-01
|
| Business code |
621391
|
| Sponsor’s telephone number |
9524352629
|
| Plan sponsor’s
address |
14000 NICOLLET AVE. S., SUITE 306, BURNSVILLE, MN, 55337
|
Signature of
| Role |
Plan administrator |
| Date |
2015-07-06 |
| Name of individual signing |
KIM D. FJELSTAD, D.P.M. |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
KIM D. FJELSTAD, D.P.M., P.A. 401(K) PLAN
|
2013
|
261436120
|
2014-09-24
|
KIM D. FJELSTAD, D.P.M., P.A.
|
3
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2011-01-01
|
| Business code |
621391
|
| Sponsor’s telephone number |
9524352629
|
| Plan sponsor’s
address |
14000 NICOLLET AVE. S., SUITE 306, BURNSVILLE, MN, 55337
|
Signature of
| Role |
Plan administrator |
| Date |
2014-09-24 |
| Name of individual signing |
ELLEN NIPP |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
KIM D. FJELSTAD, D.P.M., P.A. 401(K) PLAN
|
2012
|
261436120
|
2013-10-09
|
KIM D. FJELSTAD, D.P.M., P.A.
|
3
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2011-01-01
|
| Business code |
621391
|
| Sponsor’s telephone number |
9524352629
|
| Plan sponsor’s
address |
14000 NICOLLET AVE. S., SUITE 306, BURNSVILLE, MN, 55337
|
Signature of
| Role |
Plan administrator |
| Date |
2013-10-09 |
| Name of individual signing |
KIM D. FJELSTAD, D.P.M. |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
KIM D. FJELSTAD, D.P.M., P.A. 401(K) PLAN
|
2011
|
261436120
|
2012-10-13
|
KIM D. FJELSTAD, D.P.M., P.A.
|
3
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2011-01-01
|
| Business code |
621391
|
| Sponsor’s telephone number |
9524352629
|
| Plan sponsor’s
address |
14000 NICOLLET AVE. S., SUITE 306, BURNSVILLE, MN, 55337
|
Plan administrator’s name and address
| Administrator’s EIN |
261436120 |
| Plan administrator’s name |
KIM D. FJELSTAD, D.P.M., P.A. |
| Plan administrator’s
address |
14000 NICOLLET AVE. S., SUITE 306, BURNSVILLE, MN, 55337 |
| Administrator’s telephone number |
9524352629 |
Signature of
| Role |
Plan administrator |
| Date |
2012-10-13 |
| Name of individual signing |
ELLEN NIPP |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
