|
NORTH IDAHO FAMILY PHYSICIANS 401(K) PLAN
|
2020
|
820504320
|
2021-09-17
|
NORTH IDAHO FAMILY PHYSICIANS, LLC
|
85
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2003-01-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
2082920990
|
| Plan sponsor’s
address |
7400 MINERAL DRIVE, SUITE 400, COEUR DALENE, ID, 83815
|
Signature of
| Role |
Plan administrator |
| Date |
2021-09-17 |
| Name of individual signing |
BRYAN HANSEN |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
NORTH IDAHO FAMILY PHYSICIANS LLC HEALTH PLAN
|
2017
|
820504320
|
2019-03-25
|
NORTH IDAHO FAMILY PHYSICIANS LLC
|
121
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2017-09-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
2082920990
|
| Plan sponsor’s mailing address |
7400 N MINERAL DR STE 400, COEUR D ALENE, ID, 838155332
|
| Plan sponsor’s
address |
7400 N MINERAL DR STE 400, COEUR D ALENE, ID, 838155332
|
Number of participants as of the end of the plan year
| Active participants |
97 |
| Retired or separated participants receiving
benefits |
0 |
| Other
retired or separated participants entitled to future benefits |
0 |
| Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
| Number of
participants
with
account balances as of the end of the plan year |
0 |
| 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 |
2019-03-25 |
| Name of individual signing |
CHERYL MIKKELSEN |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
NORTH IDAHO FAMILY PHYSICIANS LLC VISION PLAN
|
2017
|
820504320
|
2019-03-25
|
NORTH IDAHO FAMILY PHYSICIANS LLC
|
118
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
502
|
| Effective date of plan |
2017-09-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
2082920990
|
| Plan sponsor’s mailing address |
7400 N MINERAL DR STE 400, COEUR D ALENE, ID, 838155332
|
| Plan sponsor’s
address |
7400 N MINERAL DR STE 400, COEUR D ALENE, ID, 838155332
|
Number of participants as of the end of the plan year
| Active participants |
92 |
| Retired or separated participants receiving
benefits |
0 |
| Other
retired or separated participants entitled to future benefits |
0 |
| Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
| Number of
participants
with
account balances as of the end of the plan year |
0 |
| 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 |
2019-03-25 |
| Name of individual signing |
CHERYL MIKKELSEN |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
NORTH IDAHO FAMILY PHYSICIANS LLC LIFE & DISABILITY PLAN
|
2017
|
820504320
|
2019-03-25
|
NORTH IDAHO FAMILY PHYSICIANS LLC
|
135
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
503
|
| Effective date of plan |
2017-09-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
2082920990
|
| Plan sponsor’s mailing address |
7400 N MINERAL DR STE 400, COEUR D ALENE, ID, 838155332
|
| Plan sponsor’s
address |
7400 N MINERAL DR STE 400, COEUR D ALENE, ID, 838155332
|
Number of participants as of the end of the plan year
| Active participants |
102 |
| Retired or separated participants receiving
benefits |
0 |
| Other
retired or separated participants entitled to future benefits |
0 |
| Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
| Number of
participants
with
account balances as of the end of the plan year |
0 |
| 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 |
2019-03-25 |
| Name of individual signing |
CHERYL MIKKELSEN |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
NORTH IDAHO FAMILY PHYSICIANS, LLC LIFE & DISABILITY PLAN
|
2016
|
820504320
|
2018-04-02
|
NORTH IDAHO FAMILY PHYSICIANS, LLC
|
128
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
503
|
| Effective date of plan |
2016-08-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
2082922935
|
| Plan sponsor’s mailing address |
700 W. IRONWOOD DR. STE 220E, COEUR D ALENE, ID, 83814
|
| Plan sponsor’s
address |
700 W. IRONWOOD DR. STE 220E, COEUR D ALENE, ID, 83814
|
Number of participants as of the end of the plan year
| Active participants |
135 |
| Retired or separated participants receiving
benefits |
0 |
| Other
retired or separated participants entitled to future benefits |
0 |
| Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
| Number of
participants
with
account balances as of the end of the plan year |
0 |
| 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 |
2018-04-02 |
| Name of individual signing |
ADAM JONES |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
NORTH IDAHO FAMILY PHYSICIANS, LLC VISION PLAN
|
2016
|
820504320
|
2018-04-02
|
NORTH IDAHO FAMILY PHYSICIANS, LLC
|
118
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
502
|
| Effective date of plan |
2016-08-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
2082922935
|
| Plan sponsor’s mailing address |
700 W. IRONWOOD DR. STE. 220E, COEUR D ALENE, ID, 83814
|
| Plan sponsor’s
address |
700 W. IRONWOOD DR. STE. 220E, COEUR D ALENE, ID, 83814
|
Number of participants as of the end of the plan year
| Active participants |
121 |
| Retired or separated participants receiving
benefits |
0 |
| Other
retired or separated participants entitled to future benefits |
0 |
| Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
| Number of
participants
with
account balances as of the end of the plan year |
0 |
| 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 |
2018-04-02 |
| Name of individual signing |
ADAM JONES |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
NORTH IDAHO FAMILY PHYSICIANS, LLC HEALTH PLAN
|
2016
|
820504320
|
2018-04-02
|
NORTH IDAHO FAMILY PHYSICIANS, LLC
|
119
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2016-08-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
2082922935
|
| Plan
sponsor’s DBA name |
NORTH IDAHO FAMILY PHYSICIANS
|
| Plan sponsor’s mailing address |
700 W. IRONWOOD DR. STE. 220E, COEUR D ALENE, ID, 83814
|
| Plan sponsor’s
address |
700 W. IRONWOOD DR. STE. 220E, COEUR D ALENE, ID, 83814
|
Number of participants as of the end of the plan year
| Active participants |
125 |
| Retired or separated participants receiving
benefits |
0 |
| Other
retired or separated participants entitled to future benefits |
0 |
| Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
| Number of
participants
with
account balances as of the end of the plan year |
0 |
| 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 |
2018-04-02 |
| Name of individual signing |
ADAM JONES |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
NORTH IDAHO FAMILY PHYSICIANS, LLC HEALTH PLAN
|
2015
|
820504320
|
2017-06-08
|
NORTH IDAHO FAMILY PHYSICIANS, LLC
|
103
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2015-08-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
2086760145
|
| Plan sponsor’s mailing address |
700 W IRONWOOD DR STE 220E, COEUR D ALENE, ID, 838144484
|
| Plan sponsor’s
address |
700 W IRONWOOD DR STE 220E, COEUR D ALENE, ID, 838144484
|
Number of participants as of the end of the plan year
| Active participants |
113 |
| Retired or separated participants receiving
benefits |
0 |
| Other
retired or separated participants entitled to future benefits |
0 |
| Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
| Number of
participants
with
account balances as of the end of the plan year |
0 |
| 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 |
2017-06-08 |
| Name of individual signing |
ERIC KOELSCH |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
NORTH IDAHO FAMILY PHYSICIANS, LLC VISION PLAN
|
2015
|
820504320
|
2017-06-08
|
NORTH IDAHO FAMILY PHYSICIANS, LLC
|
120
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
502
|
| Effective date of plan |
2015-08-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
2086760145
|
| Plan sponsor’s mailing address |
700 W IRONWOOD DR STE 220E, COEUR D ALENE, ID, 838144484
|
| Plan sponsor’s
address |
700 W IRONWOOD DR STE 220E, COEUR D ALENE, ID, 838144484
|
Number of participants as of the end of the plan year
| Active participants |
120 |
| Retired or separated participants receiving
benefits |
0 |
| Other
retired or separated participants entitled to future benefits |
0 |
| Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
| Number of
participants
with
account balances as of the end of the plan year |
0 |
| 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 |
2017-06-08 |
| Name of individual signing |
ERIC KOELSCH |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
NORTH IDAHO FAMILY PHYSICIANS, LLC LIFE AND DISABILITY PLAN
|
2015
|
820504320
|
2017-06-08
|
NORTH IDAHO FAMILY PHYSICIANS, LLC
|
128
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
503
|
| Effective date of plan |
2015-08-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
2086160145
|
| Plan sponsor’s mailing address |
700 W IRONWOOD DR STE 220E, COEUR D ALENE, ID, 838144484
|
| Plan sponsor’s
address |
700 W IRONWOOD DR STE 220E, COEUR D ALENE, ID, 838144484
|
Number of participants as of the end of the plan year
| Active participants |
128 |
| Retired or separated participants receiving
benefits |
0 |
| Other
retired or separated participants entitled to future benefits |
0 |
| Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
| Number of
participants
with
account balances as of the end of the plan year |
0 |
| 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 |
2017-06-08 |
| Name of individual signing |
ERIC KOELSCH |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
