|
DELTA BAY MEDICAL, LLC 401(K) PROFIT SHARING PLAN
|
2012
|
263758502
|
2013-10-15
|
DELTA BAY MEDICAL, LLC
|
3
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2008-01-01
|
| Business code |
446190
|
| Sponsor’s telephone number |
6019576486
|
| Plan sponsor’s
address |
731 SOUTH PEAR ORCHARD ROAD, SUITE 41, RIDGELAND, MS, 39157
|
Signature of
| Role |
Plan administrator |
| Date |
2013-10-15 |
| Name of individual signing |
DAVID R. FORD, SR. |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2013-10-15 |
| Name of individual signing |
DAVID R. FORD, SR. |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
DELTA BAY MEDICAL, LLC 401(K) PROFIT SHARING PLAN
|
2011
|
263758502
|
2012-08-01
|
DELTA BAY MEDICAL, LLC
|
20
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2008-01-01
|
| Business code |
446190
|
| Sponsor’s telephone number |
6019576486
|
| Plan sponsor’s
address |
731 SOUTH PEAR ORCHARD ROAD, SUITE 41, RIDGELAND, MS, 39157
|
Plan administrator’s name and address
| Administrator’s EIN |
263758502 |
| Plan administrator’s name |
DELTA BAY MEDICAL, LLC |
| Plan administrator’s
address |
731 SOUTH PEAR ORCHARD ROAD, SUITE 41, RIDGELAND, MS, 39157 |
| Administrator’s telephone number |
6019576486 |
Signature of
| Role |
Plan administrator |
| Date |
2012-08-01 |
| Name of individual signing |
DAVID R. FORD, SR. |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2012-08-01 |
| Name of individual signing |
DAVID R. FORD, SR. |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
DELTA BAY MEDICAL, LLC 401(K) PROFIT SHARING PLAN
|
2010
|
263758502
|
2011-10-12
|
DELTA BAY MEDICAL, LLC
|
23
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2008-01-01
|
| Business code |
446190
|
| Sponsor’s telephone number |
6019576486
|
| Plan sponsor’s
address |
731 SOUTH PEAR ORCHARD ROAD, SUITE 41, RIDGELAND, MS, 39157
|
Plan administrator’s name and address
| Administrator’s EIN |
263758502 |
| Plan administrator’s name |
DELTA BAY MEDICAL, LLC |
| Plan administrator’s
address |
731 SOUTH PEAR ORCHARD ROAD, SUITE 41, RIDGELAND, MS, 39157 |
| Administrator’s telephone number |
6019576486 |
Signature of
| Role |
Plan administrator |
| Date |
2011-10-12 |
| Name of individual signing |
ROBERT ERVIN |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2011-10-12 |
| Name of individual signing |
ROBERT ERVIN |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
DELTA BAY MEDICAL, LLC 401(K) PROFIT SHARING PLAN
|
2009
|
263758502
|
2010-10-14
|
DELTA BAY MEDICAL, LLC
|
22
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2008-01-01
|
| Business code |
446190
|
| Sponsor’s telephone number |
6019576486
|
| Plan sponsor’s
address |
731 SOUTH PEAR ORCHARD ROAD, SUITE 41, RIDGELAND, MS, 39157
|
Plan administrator’s name and address
| Administrator’s EIN |
263758502 |
| Plan administrator’s name |
DELTA BAY MEDICAL, LLC |
| Plan administrator’s
address |
731 SOUTH PEAR ORCHARD ROAD, SUITE 41, RIDGELAND, MS, 39157 |
| Administrator’s telephone number |
6019576486 |
Signature of
| Role |
Plan administrator |
| Date |
2010-10-14 |
| Name of individual signing |
JON PAUL BOBO |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2010-10-14 |
| Name of individual signing |
JON PAUL BOBO |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
