| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
1988-01-01
|
| Business code |
622000
|
| Sponsor’s telephone number |
2083542383
|
| Plan sponsor’s
address |
120 EAST HOWARD AVENUE, DRIGGS, ID, 83422
|
Plan administrator’s name and address
| Administrator’s EIN |
820214415 |
| Plan administrator’s name |
TETON VALLEY HOSPITAL |
| Plan administrator’s
address |
120 EAST HOWARD AVENUE, DRIGGS, ID, 83422 |
| Administrator’s telephone number |
2083542383 |
Signature of
| Role |
Plan administrator |
| Date |
2010-10-11 |
| Name of individual signing |
BLAINE RIPPLINGER |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2010-10-11 |
| Name of individual signing |
BLAINE RIPPLINGER |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
