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| Plan Name | JANE L. FORREST, M.D., PROFESSIONAL ASSOCIATION PROFIT SHARING PLAN |
| Plan identification number | 002 |
| 401k Plan Type | Defined Contribution Pension |
| Plan Features/Benefits |
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| Company Name: | JANE L. FORREST, M.D., PROFESSIONAL ASSOCIATION |
| Employer identification number (EIN): | 020357033 |
| NAIC Classification: | 621111 |
| NAIC Description: | Offices of Physicians (except Mental Health Specialists) |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 002 | 2015-01-01 | JANE L FORREST | 2015-10-08 | ||
| 002 | 2014-01-01 | JANE L FORREST | 2015-07-07 | JANE L FORREST | 2015-07-07 |
| 002 | 2013-01-01 | NANCY DIVOLL | 2014-06-03 | JANE L FORREST | 2014-06-03 |
| 002 | 2012-01-01 | JANE L FORREST MD | 2013-07-18 | JANE L FORRERST MD | 2013-07-18 |
| 002 | 2011-01-01 | JANE L FORREST M.D. | 2012-07-26 | JANE L FORREST M.D. | 2012-07-26 |
| 002 | 2010-01-01 | JANE FORREST | 2011-04-19 | JANE FORREST | 2011-04-19 |
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