|
BLUEGRASS VISION GROUP 401K PLAN
|
2023
|
813724927
|
2024-09-25
|
BLUEGRASS VISION GROUP, PLLC
|
18
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2022-01-01
|
| Business code |
621320
|
| Sponsor’s telephone number |
6064224960
|
| Plan sponsor’s
address |
25 STERLING WAY, STE C, MT STERLING, KY, 40353
|
|
|
BLUEGRASS VISION GROUP 401K PLAN
|
2022
|
813724927
|
2023-10-13
|
BLUEGRASS VISION GROUP, PLLC
|
18
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2022-01-01
|
| Business code |
621320
|
| Sponsor’s telephone number |
6064224960
|
| Plan sponsor’s
address |
25 STERLING WAY, STE C, MT STERLING, KY, 40353
|
|
|
BLUEGRASS VISION GROUP CBS BENEFIT PLAN
|
2022
|
813724927
|
2023-12-27
|
BLUEGRASS VISION GROUP
|
8
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2020-01-01
|
| Business code |
621320
|
| Sponsor’s telephone number |
8594984800
|
| Plan sponsor’s
address |
25 STERLING WAY, MOUNT STERLIN, KY, 40353
|
Plan administrator’s name and address
| Administrator’s EIN |
846429706 |
| Plan administrator’s name |
SHAWNA BURTON |
| Plan administrator’s
address |
464 CHENAULT RD, FRANKFORT, KY, 40601 |
| Administrator’s telephone number |
5026954700 |
Signature of
| Role |
Plan administrator |
| Date |
2023-12-27 |
| Name of individual signing |
SHAWNA BURTON |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
BLUEGRASS VISION GROUP CBS BENEFIT PLAN
|
2021
|
813724927
|
2022-12-29
|
BLUEGRASS VISION GROUP
|
7
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2020-01-01
|
| Business code |
621320
|
| Sponsor’s telephone number |
8594984800
|
| Plan sponsor’s
address |
25 STERLING WAY, MOUNT STERLIN, KY, 40353
|
Plan administrator’s name and address
| Administrator’s EIN |
846429706 |
| Plan administrator’s name |
SHAWNA BURTON |
| Plan administrator’s
address |
464 CHENAULT RD, FRANKFORT, KY, 40601 |
| Administrator’s telephone number |
5026954700 |
Signature of
| Role |
Plan administrator |
| Date |
2022-12-29 |
| Name of individual signing |
SHAWNA BURTON |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
BLUEGRASS VISION GROUP CBS BENEFIT PLAN
|
2020
|
813724927
|
2021-12-14
|
BLUEGRASS VISION GROUP
|
6
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2020-01-01
|
| Business code |
621320
|
| Sponsor’s telephone number |
8594984800
|
| Plan sponsor’s
address |
25 STERLING WAY, MOUNT STERLIN, KY, 40353
|
Plan administrator’s name and address
| Administrator’s EIN |
846429706 |
| Plan administrator’s name |
SHAWNA BURTON |
| Plan administrator’s
address |
464 CHENAULT RD, FRANKFORT, KY, 40601 |
| Administrator’s telephone number |
5026954700 |
Signature of
| Role |
Plan administrator |
| Date |
2021-12-14 |
| Name of individual signing |
SHAWNA BURTON |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
BLUEGRASS VISION GROUP CBS BENEFIT PLAN
|
2019
|
813724927
|
2020-12-23
|
BLUEGRASS VISION GROUP
|
4
|
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2020-01-01
|
| Business code |
621320
|
| Sponsor’s telephone number |
8594984800
|
| Plan sponsor’s
address |
25 STERLING WAY, MOUNT STERLIN, KY, 40353
|
Plan administrator’s name and address
| Administrator’s EIN |
846429706 |
| Plan administrator’s name |
KELLY WOLF |
| Plan administrator’s
address |
464 CHENAULT RD, FRANKFORT, KY, 40601 |
| Administrator’s telephone number |
5026954700 |
Signature of
| Role |
Plan administrator |
| Date |
2020-12-23 |
| Name of individual signing |
KELLY WOLF |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
