IDAHO PACIFIC CORPORATION HEALTH, DENTAL, VISION PLAN
|
2023
|
820415407
|
2024-05-28
|
IDAHO PACIFIC CORPORATION
|
380
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2022-01-01
|
Business code |
311900
|
Sponsor’s telephone number |
2085386971
|
Plan sponsor’s mailing address |
4723 E 100 N, RIGBY, ID, 834425811
|
Plan sponsor’s
address |
4723 E 100 N, RIGBY, ID, 834425811
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2024-05-28 |
Name of individual signing |
DIANE LOCKARD |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2024-05-28 |
Name of individual signing |
DIANE LOCKARD |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
IDAHO PACIFIC CORPORATION LIFE AND DISABILITY
|
2023
|
820415407
|
2024-05-28
|
IDAHO PACIFIC CORPORATION
|
385
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
2021-01-01
|
Business code |
311900
|
Sponsor’s telephone number |
2085386971
|
Plan sponsor’s mailing address |
4723 E 100 N, RIGBY, ID, 834425811
|
Plan sponsor’s
address |
4723 E 100 N, RIGBY, ID, 834425811
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2024-05-28 |
Name of individual signing |
DIANE LOCKARD |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2024-05-28 |
Name of individual signing |
DIANE LOCKARD |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
IDAHO PACIFIC CORPORATION HEALTH, DENTAL, VISION PLAN
|
2022
|
820415407
|
2023-09-08
|
IDAHO PACIFIC CORPORATION
|
310
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
2022-01-01
|
Business code |
311900
|
Sponsor’s telephone number |
2085386971
|
Plan sponsor’s mailing address |
4723 E 100 N, RIGBY, ID, 834425811
|
Plan sponsor’s
address |
4723 E 100 N, RIGBY, ID, 834425811
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2023-09-08 |
Name of individual signing |
DIANE LOCKARD |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2023-09-08 |
Name of individual signing |
DIANE LOCKARD |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
IDAHO PACIFIC CORPORATION LIFE AND DISABILITY
|
2022
|
820415407
|
2023-09-08
|
IDAHO PACIFIC CORPORATION
|
378
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
2021-01-01
|
Business code |
311900
|
Sponsor’s telephone number |
2085386971
|
Plan sponsor’s mailing address |
4723 E 100 N, RIGBY, ID, 834425811
|
Plan sponsor’s
address |
4723 E 100 N, RIGBY, ID, 834425811
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2023-09-08 |
Name of individual signing |
DIANE LOCKARD |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2023-09-08 |
Name of individual signing |
DIANE LOCKARD |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
IDAHO PACIFIC CORPORATION LIFE AND DISABILITY PLAN
|
2017
|
820415407
|
2018-06-22
|
IDAHO PACIFIC CORPORATION
|
190
|
|
File |
View Page
|
Three-digit plan number (PN) |
504
|
Effective date of plan |
1999-01-01
|
Business code |
311900
|
Sponsor’s telephone number |
2085386971
|
Plan sponsor’s mailing address |
PO BOX 478, RIRIE, ID, 834430478
|
Plan sponsor’s
address |
PO BOX 478, RIRIE, ID, 834430478
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2018-06-22 |
Name of individual signing |
MIKE WILLMORE |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-06-22 |
Name of individual signing |
MIKE WILLMORE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
IDAHO PACIFIC CORPORATION HEALTH INSURANCE PLAN
|
2017
|
820415407
|
2018-06-22
|
IDAHO PACIFIC CORPORATION
|
190
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
1999-01-01
|
Business code |
311900
|
Sponsor’s telephone number |
2085386971
|
Plan sponsor’s mailing address |
PO BOX 478, RIRIE, ID, 834430478
|
Plan sponsor’s
address |
PO BOX 478, RIRIE, ID, 834430478
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2018-06-21 |
Name of individual signing |
MIKE WILLMORE |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-06-21 |
Name of individual signing |
MIKE WILLMORE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
IDAHO PACIFIC CORPORATION DENTAL INSURANCE PLAN
|
2017
|
820415407
|
2018-06-22
|
IDAHO PACIFIC CORPORATION
|
190
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1999-01-01
|
Business code |
311900
|
Sponsor’s telephone number |
2085386971
|
Plan sponsor’s mailing address |
PO BOX 478, RIRIE, ID, 834430478
|
Plan sponsor’s
address |
PO BOX 478, RIRIE, ID, 834430478
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2018-06-21 |
Name of individual signing |
MIKE WILLMORE |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2018-06-21 |
Name of individual signing |
MIKE WILLMORE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
IDAHO PACIFIC CORPORATION HEALTH INSURANCE PLAN
|
2016
|
820415407
|
2017-06-29
|
IDAHO PACIFIC CORPORATION
|
211
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
1999-01-01
|
Business code |
311900
|
Sponsor’s telephone number |
2085386971
|
Plan sponsor’s mailing address |
PO BOX 478, RIRIE, ID, 834430478
|
Plan sponsor’s
address |
PO BOX 478, RIRIE, ID, 834430478
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2017-06-29 |
Name of individual signing |
MIKE WILLMORE |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2017-06-29 |
Name of individual signing |
MIKE WILLMORE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
IDAHO PACIFIC CORPORATION LIFE AND DISABILITY PLAN
|
2016
|
820415407
|
2017-06-29
|
IDAHO PACIFIC CORPORATION
|
223
|
|
File |
View Page
|
Three-digit plan number (PN) |
504
|
Effective date of plan |
1999-01-01
|
Business code |
311900
|
Sponsor’s telephone number |
2085386971
|
Plan sponsor’s mailing address |
PO BOX 478, RIRIE, ID, 834430478
|
Plan sponsor’s
address |
PO BOX 478, RIRIE, ID, 83443
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2017-06-29 |
Name of individual signing |
MIKE WILLMORE |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2017-06-29 |
Name of individual signing |
MIKE WILLMORE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
IDAHO PACIFIC CORPORATION DENTAL INSURANCE PLAN
|
2016
|
820415407
|
2017-06-29
|
IDAHO PACIFIC CORPORATION
|
211
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1999-01-01
|
Business code |
311900
|
Sponsor’s telephone number |
2085386971
|
Plan sponsor’s mailing address |
PO BOX 478, RIRIE, ID, 834430478
|
Plan sponsor’s
address |
PO BOX 478, RIRIE, ID, 834430478
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2017-06-29 |
Name of individual signing |
MIKE WILLMORE |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2017-06-29 |
Name of individual signing |
MIKE WILLMORE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|