|
NEILS W LARSEN 401(K) PROFIT SHARING PLAN
|
2012
|
202710196
|
2013-07-30
|
LARSEN DENTAL, LLC
|
7
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
1998-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2082337007
|
| Plan sponsor’s
address |
950 HOSPTIAL WAY, SUITE B, POCATELLO, ID, 83201
|
Plan administrator’s name and address
| Administrator’s EIN |
202710196 |
| Plan administrator’s name |
LARSEN DENTAL, LLC |
| Plan administrator’s
address |
950 HOSPTIAL WAY, SUITE B, POCATELLO, ID, 83201 |
| Administrator’s telephone number |
2082337007 |
Signature of
| Role |
Plan administrator |
| Date |
2013-07-30 |
| Name of individual signing |
BRYCE LARSEN |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
NEILS W LARSEN 401(K) PROFIT SHARING PLAN
|
2011
|
202710196
|
2012-09-21
|
LARSEN DENTAL, LLC
|
7
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
1998-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2082337007
|
| Plan sponsor’s
address |
950 HOSPTIAL WAY, SUITE B, POCATELLO, ID, 83201
|
Plan administrator’s name and address
| Administrator’s EIN |
202710196 |
| Plan administrator’s name |
LARSEN DENTAL, LLC |
| Plan administrator’s
address |
950 HOSPTIAL WAY, SUITE B, POCATELLO, ID, 83201 |
| Administrator’s telephone number |
2082337007 |
Signature of
| Role |
Plan administrator |
| Date |
2012-09-21 |
| Name of individual signing |
NEIL LARSEN |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
NEILS W LARSEN 401(K) PROFIT SHARING PLAN
|
2010
|
202710196
|
2011-07-20
|
LARSEN DENTAL, LLC
|
8
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
1998-01-01
|
| Business code |
621210
|
| Sponsor’s telephone number |
2082337007
|
| Plan sponsor’s mailing address |
950 HOSPITAL WAY, SUITE B, POCATELLO, ID, 83201
|
| Plan sponsor’s
address |
950 HOSPITAL WAY, SUITE B, POCATELLO, ID, 83201
|
Plan administrator’s name and address
| Administrator’s EIN |
202710196 |
| Plan administrator’s name |
LARSEN DENTAL, LLC |
| Plan administrator’s
address |
950 HOSPITAL WAY, SUITE B, POCATELLO, ID, 83201 |
| Administrator’s telephone number |
2082337007 |
Number of participants as of the end of the plan year
| Active participants |
5 |
| Other
retired or separated participants entitled to future benefits |
2 |
| Number of
participants
with
account balances as of the end of the plan year |
7 |
| Number of participants that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
0 |
Signature of
| Role |
Plan administrator |
| Date |
2011-07-20 |
| Name of individual signing |
NEIL LARSEN |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
