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  5. THREE RIVERS INSURANCE, INC.

THREE RIVERS INSURANCE, INC.

Company Details

Name: THREE RIVERS INSURANCE, INC.
Jurisdiction: Idaho
Legal type: General Business Corporation (D)
Status: Active-Good Standing
Date of registration: 19 Jun 1980 (45 years ago)
Financial Date End: 30 Jun 2025
Entity Number: 203490
Place of Formation: IDAHO
File Number: 203490
ZIP code: 83661
County: Payette County
Mailing Address: PO BOX 219 PAYETTE, ID 83661-0219

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
THREE RIVERS INSURANCE, INC 401(K) PROFIT SHARING PLAN 2022 820357824 2024-05-15 THREE RIVERS INSURANCE, INC. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1980-11-01
Business code 524210
Sponsor’s telephone number 2086429311
Plan sponsor’s address 26 SOUTH MAIN S, PAYETTE, ID, 83661

Plan administrator’s name and address
Administrator’s EIN 820357824
Plan administrator’s name THREE RIVERS INSURANCE, INC.
Plan administrator’s address 26 SOUTH MAIN S, PAYETTE, ID, 83661
Administrator’s telephone number 2086429311

Signature of
Role Plan administrator
Date 2024-05-15
Name of individual signing JULIE BARNETT
Valid signature Filed with authorized/valid electronic signature
THREE RIVERS INSURANCE, INC 401(K) PROFIT SHARING PLAN 2021 820357824 2023-06-14 THREE RIVERS INSURANCE, INC. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1980-11-01
Business code 524210
Sponsor’s telephone number 2086429311
Plan sponsor’s address 26 SOUTH MAIN S, PAYETTE, ID, 83661

Plan administrator’s name and address
Administrator’s EIN 820357824
Plan administrator’s name THREE RIVERS INSURANCE, INC.
Plan administrator’s address 26 SOUTH MAIN S, PAYETTE, ID, 83661
Administrator’s telephone number 2086429311

Signature of
Role Plan administrator
Date 2023-06-14
Name of individual signing DAVE GRAY
Valid signature Filed with authorized/valid electronic signature
THREE RIVERS INSURANCE, INC 401(K) PROFIT SHARING PLAN 2020 820357824 2022-09-01 THREE RIVERS INSURANCE, INC. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1980-11-01
Business code 524210
Sponsor’s telephone number 2086429311
Plan sponsor’s address 26 SOUTH MAIN S, PAYETTE, ID, 83661

Plan administrator’s name and address
Administrator’s EIN 820357824
Plan administrator’s name THREE RIVERS INSURANCE, INC.
Plan administrator’s address 26 SOUTH MAIN S, PAYETTE, ID, 83661
Administrator’s telephone number 2086429311

Signature of
Role Plan administrator
Date 2022-09-01
Name of individual signing DAVE GRAY
Valid signature Filed with authorized/valid electronic signature
THREE RIVERS INSURANCE, INC 401(K) PROFIT SHARING PLAN 2019 820357824 2021-01-12 THREE RIVERS INSURANCE, INC. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1980-11-01
Business code 524210
Sponsor’s telephone number 2086429311
Plan sponsor’s address 26 SOUTH MAIN S, PAYETTE, ID, 83661

Plan administrator’s name and address
Administrator’s EIN 820357824
Plan administrator’s name THREE RIVERS INSURANCE, INC.
Plan administrator’s address 26 SOUTH MAIN S, PAYETTE, ID, 83661
Administrator’s telephone number 2086429311

Signature of
Role Plan administrator
Date 2021-01-12
Name of individual signing DAVE GRAY
Valid signature Filed with authorized/valid electronic signature
THREE RIVERS INSURANCE, INC 401(K) PROFIT SHARING PLAN 2018 820357824 2020-01-29 THREE RIVERS INSURANCE, INC. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1980-11-01
Business code 524210
Sponsor’s telephone number 2086429311
Plan sponsor’s address 26 SOUTH MAIN S, PAYETTE, ID, 83661

Plan administrator’s name and address
Administrator’s EIN 820357824
Plan administrator’s name THREE RIVERS INSURANCE, INC.
Plan administrator’s address 26 SOUTH MAIN S, PAYETTE, ID, 83661
Administrator’s telephone number 2086429311

Signature of
Role Plan administrator
Date 2020-01-29
Name of individual signing DAVE GRAY
Valid signature Filed with authorized/valid electronic signature
THREE RIVERS INSURANCE, INC 401(K) PROFIT SHARING PLAN 2017 820357824 2019-01-28 THREE RIVERS INSURANCE, INC. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1980-11-01
Business code 524210
Sponsor’s telephone number 2086429311
Plan sponsor’s address 26 SOUTH MAIN S, PAYETTE, ID, 83661

Plan administrator’s name and address
Administrator’s EIN 820357824
Plan administrator’s name THREE RIVERS INSURANCE, INC.
Plan administrator’s address 26 SOUTH MAIN S, PAYETTE, ID, 83661
Administrator’s telephone number 2086429311

Signature of
Role Plan administrator
Date 2019-01-28
Name of individual signing DAVE GRAY
Valid signature Filed with authorized/valid electronic signature
THREE RIVERS INSURANCE, INC 401(K) PROFIT SHARING PLAN 2016 820357824 2018-01-12 THREE RIVERS INSURANCE, INC. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1980-11-01
Business code 524210
Sponsor’s telephone number 2086429311
Plan sponsor’s address 26 SOUTH MAIN S, PAYETTE, ID, 83661

Plan administrator’s name and address
Administrator’s EIN 820357824
Plan administrator’s name THREE RIVERS INSURANCE, INC.
Plan administrator’s address 26 SOUTH MAIN S, PAYETTE, ID, 83661
Administrator’s telephone number 2086429311

Signature of
Role Plan administrator
Date 2018-01-12
Name of individual signing DAVE GRAY
Valid signature Filed with authorized/valid electronic signature
THREE RIVERS INSURANCE, INC 401(K) PROFIT SHARING PLAN 2015 820357824 2017-03-16 THREE RIVERS INSURANCE, INC. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1980-11-01
Business code 524210
Sponsor’s telephone number 2086429311
Plan sponsor’s address 26 SOUTH MAIN S, PAYETTE, ID, 83661

Plan administrator’s name and address
Administrator’s EIN 820357824
Plan administrator’s name THREE RIVERS INSURANCE, INC.
Plan administrator’s address 26 SOUTH MAIN S, PAYETTE, ID, 83661
Administrator’s telephone number 2086429311

Signature of
Role Plan administrator
Date 2017-03-16
Name of individual signing DAVE GRAY
Valid signature Filed with authorized/valid electronic signature
THREE RIVERS INSURANCE, INC 401(K) PROFIT SHARING PLAN 2014 820357824 2016-06-01 THREE RIVERS INSURANCE, INC. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1980-11-01
Business code 524210
Sponsor’s telephone number 2086429311
Plan sponsor’s address 26 SOUTH MAIN S, PAYETTE, ID, 83661

Plan administrator’s name and address
Administrator’s EIN 820357824
Plan administrator’s name THREE RIVERS INSURANCE, INC.
Plan administrator’s address 26 SOUTH MAIN S, PAYETTE, ID, 83661
Administrator’s telephone number 2086429311

Signature of
Role Plan administrator
Date 2016-06-01
Name of individual signing DAVE GRAY
Valid signature Filed with authorized/valid electronic signature
THREE RIVERS INSURANCE, INC 401(K) PROFIT SHARING PLAN 2013 820357824 2014-12-12 THREE RIVERS INSURANCE, INC. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1980-11-01
Business code 524210
Sponsor’s telephone number 2086429311
Plan sponsor’s address 26 SOUTH MAIN S, PAYETTE, ID, 83661

Plan administrator’s name and address
Administrator’s EIN 820357824
Plan administrator’s name THREE RIVERS INSURANCE, INC.
Plan administrator’s address 26 SOUTH MAIN S, PAYETTE, ID, 83661
Administrator’s telephone number 2086429311

Signature of
Role Plan administrator
Date 2014-12-12
Name of individual signing DAVE GRAY
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
DAVID T GRAY Agent 26 S MAIN, PAYETTE, ID 83661

Treasurer

Name Role Address Appointed On
Michael Hillman Treasurer 4645 S. LIPPIZAN, BOISE, ID 83709 2024-05-04

Secretary

Name Role Address Appointed On
Michael S Holcomb Secretary 860 HUGHES DRIVE, PAYETTE, ID 83661-2849 2024-05-04

President

Name Role Address Appointed On
David T Gray President 12230 HILL RD, PAYETTTE, ID 83661 2021-06-03

Filing

Filing Name Filing Number Filing date
Annual Report 0005722954 2024-05-04
Annual Report 0005219354 2023-05-03
Annual Report 0004724581 2022-05-03
Annual Report 0004301808 2021-06-03
Annual Report 0003864816 2020-05-04
Annual Report 0003515076 2019-05-17
Annual Report 0001733398 2018-04-23
Annual Report 0001733396 2017-04-30
Annual Report 0001733394 2016-04-26
Annual Report 0001733376 2015-04-17

Related by officers

Michael Hillman

E-LOGISTICS, L.L.C. KAVORKA CO. LLC COEUR D' ALENE ID CAREGIVING, LLC POCATELLO ID CAREGIVING, LLC Boise Kava LLC

Michael S Holcomb

PAYETTE MUNICIPAL DEVELOPMENT CORPORATION

David T Gray

GRANITE PROPERTIES, LLC

Related by address

PO BOX 219 PAYETTE, ID 83661-0219

KAVORKA CO. LLC

Date of last update: 05 Dec 2024

Sources: Idaho Secretary of State

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