BLUE BACK DENTAL, LLC 401(K) PROFIT SHARING TRUST
|
2023
|
451623829
|
2024-05-21
|
BLUE BACK DENTAL, LLC
|
40
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1994-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8602339300
|
Plan sponsor’s
address |
65 MEMORIAL ROAD, SUITE 400, WEST HARTFORD, CT, 06107
|
Signature of
Role |
Plan administrator |
Date |
2024-05-21 |
Name of individual signing |
THEODORE WU |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BLUE BACK DENTAL, LLC 401(K) PROFIT SHARING TRUST
|
2022
|
451623829
|
2023-08-23
|
BLUE BACK DENTAL, LLC
|
32
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1994-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8602339300
|
Plan sponsor’s
address |
65 MEMORIAL ROAD, SUITE 400, WEST HARTFORD, CT, 06107
|
Signature of
Role |
Plan administrator |
Date |
2023-08-23 |
Name of individual signing |
THEODORE WU |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BLUE BACK DENTAL, LLC 401(K) PROFIT SHARING TRUST
|
2021
|
451623829
|
2022-04-27
|
BLUE BACK DENTAL, LLC
|
31
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1994-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8602339300
|
Plan sponsor’s
address |
65 MEMORIAL ROAD, SUITE 400, WEST HARTFORD, CT, 06107
|
Signature of
Role |
Plan administrator |
Date |
2022-04-27 |
Name of individual signing |
THEODORE WU |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2022-04-27 |
Name of individual signing |
THEODORE WU |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BLUE BACK DENTAL, LLC 401(K) PROFIT SHARING TRUST
|
2020
|
451623829
|
2021-07-27
|
BLUE BACK DENTAL, LLC
|
20
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1994-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8602339300
|
Plan sponsor’s
address |
65 MEMORIAL ROAD, SUITE 400, WEST HARTFORD, CT, 06107
|
Signature of
Role |
Plan administrator |
Date |
2021-07-27 |
Name of individual signing |
THEODORE WU |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BLUE BACK DENTAL, LLC 401(K) PROFIT SHARING TRUST
|
2019
|
451623829
|
2020-06-30
|
BLUE BACK DENTAL, LLC
|
14
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2019-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8602339300
|
Plan sponsor’s
address |
65 MEMORIAL ROAD, SUITE 400, WEST HARTFORD, CT, 06107
|
Signature of
Role |
Plan administrator |
Date |
2020-06-30 |
Name of individual signing |
THEODORE WU |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BLUE BACK DENTAL, LLC 401(K) PROFIT SHARING PLAN
|
2018
|
451623829
|
2019-06-12
|
BLUE BACK DENTAL, LLC
|
15
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1994-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8602339300
|
Plan sponsor’s
address |
65 MEMORIAL ROAD, SUITE 400, WEST HARTFORD, CT, 06107
|
Signature of
Role |
Plan administrator |
Date |
2019-06-12 |
Name of individual signing |
TED WU |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BLUE BACK DENTAL, LLC 401(K) PROFIT SHARING PLAN
|
2017
|
451623829
|
2018-07-02
|
BLUE BACK DENTAL, LLC
|
15
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1994-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8602339300
|
Plan sponsor’s
address |
65 MEMORIAL ROAD, SUITE 400, WEST HARTFORD, CT, 06107
|
Signature of
Role |
Plan administrator |
Date |
2018-07-02 |
Name of individual signing |
TED WU |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BLUE BACK DENTAL, LLC 401(K) PROFIT SHARING PLAN
|
2016
|
451623829
|
2017-05-31
|
BLUE BACK DENTAL, LLC
|
16
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1994-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8602339300
|
Plan sponsor’s
address |
65 MEMORIAL ROAD, SUITE 400, WEST HARTFORD, CT, 06107
|
Signature of
Role |
Plan administrator |
Date |
2017-05-31 |
Name of individual signing |
TED WU |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BLUE BACK DENTAL, LLC 401(K) PROFIT SHARING PLAN
|
2015
|
451623829
|
2016-07-01
|
BLUE BACK DENTAL, LLC
|
15
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1994-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8602339300
|
Plan sponsor’s
address |
65 MEMORIAL ROAD, SUITE 400, WEST HARTFORD, CT, 06107
|
Signature of
Role |
Plan administrator |
Date |
2016-07-01 |
Name of individual signing |
TED WU |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
BLUE BACK DENTAL, LLC 401(K) PROFIT SHARING PLAN
|
2014
|
451623829
|
2015-05-12
|
BLUE BACK DENTAL, LLC
|
14
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1994-01-01
|
Business code |
621210
|
Sponsor’s telephone number |
8602339300
|
Plan sponsor’s
address |
65 MEMORIAL ROAD, SUITE 400, WEST HARTFORD, CT, 06107
|
Signature of
Role |
Plan administrator |
Date |
2015-05-12 |
Name of individual signing |
KIRSTEN ZETTERGREN |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2015-05-12 |
Name of individual signing |
KIRSTEN ZETTERGREN |
Valid signature |
Filed with authorized/valid electronic signature |
|
|