DUANE T. GOLOMB, M.D., INC. RETIREMENT PLAN
|
2018
|
050501016
|
2019-01-14
|
DUANE T. GOLOMB, M.D., INC.
|
11
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1992-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
4018222807
|
Plan sponsor’s
address |
595 WASHINGTON STREET, COVENTRY, RI, 028165486
|
Signature of
Role |
Plan administrator |
Date |
2019-01-14 |
Name of individual signing |
DUANE GOLOMB |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2019-01-14 |
Name of individual signing |
DUANE GOLOMB |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
DUANE T. GOLOMB, M.D., INC. RETIREMENT PLAN
|
2017
|
050501016
|
2018-06-12
|
DUANE T. GOLOMB, M.D., INC.
|
11
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1992-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
4018222807
|
Plan sponsor’s
address |
595 WASHINGTON STREET, COVENTRY, RI, 028165486
|
Signature of
Role |
Plan administrator |
Date |
2018-06-12 |
Name of individual signing |
DUANE GOLOMB |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-06-12 |
Name of individual signing |
DUANE GOLOMB |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
DUANE T. GOLOMB, M.D., INC. RETIREMENT PLAN
|
2016
|
050501016
|
2017-03-30
|
DUANE T. GOLOMB, M.D., INC.
|
10
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1992-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
4018222807
|
Plan sponsor’s
address |
595 WASHINGTON STREET, COVENTRY, RI, 028165486
|
Signature of
Role |
Plan administrator |
Date |
2017-03-30 |
Name of individual signing |
DUANE GOLOMB |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2017-03-30 |
Name of individual signing |
DUANE GOLOMB |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
DUANE T. GOLOMB, M.D., INC. RETIREMENT PLAN
|
2015
|
050501016
|
2016-07-06
|
DUANE T. GOLOMB, M.D., INC.
|
9
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1992-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
4018222807
|
Plan sponsor’s
address |
595 WASHINGTON STREET, COVENTRY, RI, 028165486
|
Signature of
Role |
Plan administrator |
Date |
2016-07-06 |
Name of individual signing |
DUANE GOLOMB |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2016-07-06 |
Name of individual signing |
DUANE GOLOMB |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
DUANE T. GOLOMB, M.D., INC. RETIREMENT PLAN
|
2014
|
050501016
|
2015-08-04
|
DUANE T. GOLOMB, M.D., INC.
|
9
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1992-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
4018222807
|
Plan sponsor’s
address |
595 WASHINGTON STREET, COVENTRY, RI, 028165486
|
Signature of
Role |
Plan administrator |
Date |
2015-08-04 |
Name of individual signing |
DUANE GOLOMB |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2015-08-04 |
Name of individual signing |
DUANE GOLOMB |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
DUANE T. GOLOMB, M.D., INC. RETIREMENT PLAN
|
2013
|
050501016
|
2014-06-12
|
DUANE T. GOLOMB, M.D., INC.
|
10
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1992-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
4018222807
|
Plan sponsor’s
address |
595 WASHINGTON STREET, COVENTRY, RI, 028165486
|
Signature of
Role |
Plan administrator |
Date |
2014-06-12 |
Name of individual signing |
DUANE GOLOMB |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2014-06-12 |
Name of individual signing |
DUANE GOLOMB |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
DUANE T. GOLOMB, M.D., INC. RETIREMENT PLAN
|
2012
|
050501016
|
2013-07-03
|
DUANE T. GOLOMB, M.D., INC.
|
10
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1992-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
4018222807
|
Plan sponsor’s
address |
595 WASHINGTON STREET, COVENTRY, RI, 028165486
|
Signature of
Role |
Plan administrator |
Date |
2013-07-03 |
Name of individual signing |
DUANE GOLOMB |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2013-07-03 |
Name of individual signing |
DUANE GOLOMB |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
DUANE T. GOLOMB, M.D., INC. RETIREMENT PLAN
|
2011
|
050501016
|
2012-07-11
|
DUANE T. GOLOMB, M.D., INC.
|
11
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1992-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
4018222807
|
Plan sponsor’s
address |
766 WASHINGTON STREET, COVENTRY, RI, 028165486
|
Plan administrator’s name and address
Administrator’s EIN |
050501016 |
Plan administrator’s name |
DUANE T. GOLOMB, M.D., INC. |
Plan administrator’s
address |
766 WASHINGTON STREET, COVENTRY, RI, 028165486 |
Administrator’s telephone number |
4018222807 |
Signature of
Role |
Plan administrator |
Date |
2012-07-11 |
Name of individual signing |
DUANE GOLOMB |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2012-07-11 |
Name of individual signing |
DUANE GOLOMB |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
DUANE T. GOLOMB, M.D., INC. RETIREMENT PLAN
|
2010
|
050501016
|
2011-07-19
|
DUANE T. GOLOMB, M.D., INC.
|
11
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1992-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
4018222807
|
Plan sponsor’s
address |
766 WASHINGTON STREET, COVENTRY, RI, 028165486
|
Plan administrator’s name and address
Administrator’s EIN |
050501016 |
Plan administrator’s name |
DUANE T. GOLOMB, M.D., INC. |
Plan administrator’s
address |
766 WASHINGTON STREET, COVENTRY, RI, 028165486 |
Administrator’s telephone number |
4018222807 |
Signature of
Role |
Plan administrator |
Date |
2011-07-19 |
Name of individual signing |
DUANE GOLOMB |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2011-07-19 |
Name of individual signing |
DUANE GOLOMB |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
DUANE T. GOLOMB, M.D., INC. RETIREMENT PLAN
|
2009
|
050501016
|
2010-09-27
|
DUANE T. GOLOMB, M.D., INC.
|
11
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
1992-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
4018222807
|
Plan sponsor’s
address |
766 WASHINGTON STREET, COVENTRY, RI, 028165486
|
Plan administrator’s name and address
Administrator’s EIN |
050501016 |
Plan administrator’s name |
DUANE T. GOLOMB, M.D., INC. |
Plan administrator’s
address |
766 WASHINGTON STREET, COVENTRY, RI, 028165486 |
Administrator’s telephone number |
4018222807 |
Signature of
Role |
Plan administrator |
Date |
2010-09-27 |
Name of individual signing |
DUANE GOLOMB |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2010-09-27 |
Name of individual signing |
DUANE GOLOMB |
Valid signature |
Filed with authorized/valid electronic signature |
|
|