DAVIS FAMILY MEDICINE 401(K) PROFIT SHARING PLAN
|
2020
|
680569751
|
2021-07-30
|
ASHLEY A. DAVIS, M.D., P.C.
|
10
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2013-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
2084299100
|
Plan sponsor’s
address |
222 N 2ND ST, SUITE 204, BOISE, ID, 83702
|
Plan administrator’s name and address
Administrator’s EIN |
842925395 |
Plan administrator’s name |
401GO, INC. |
Plan administrator’s
address |
8427 OLD BINGHAM HIGHWAY, SUITE A, WEST JORDAN, UT, 84088 |
Administrator’s telephone number |
8012142125 |
Signature of
Role |
Plan administrator |
Date |
2021-07-29 |
Name of individual signing |
FIDUCIARY ASSISTANCE |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
DAVIS FAMILY MEDICINE 401(K) PROFIT SHARING PLAN
|
2019
|
680569751
|
2020-06-24
|
ASHLEY A. DAVIS, M.D., P.C.
|
11
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2013-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
2084299100
|
Plan sponsor’s
address |
222 NORTH SECOND STREET, SUITE 204, BOISE, ID, 83702
|
|
DAVIS FAMILY MEDICINE 401(K) PROFIT SHARING PLAN
|
2018
|
680569751
|
2019-04-26
|
ASHLEY A. DAVIS, M.D., P.C.
|
9
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2013-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
2084299100
|
Plan sponsor’s
address |
222 NORTH SECOND STREET, SUITE 204, BOISE, ID, 83702
|
Signature of
Role |
Plan administrator |
Date |
2019-04-26 |
Name of individual signing |
ASHLEY A. DAVIS |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
DAVIS FAMILY MEDICINE 401(K) PROFIT SHARING PLAN
|
2017
|
680569751
|
2018-04-02
|
ASHLEY A. DAVIS, M.D., P.C.
|
7
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2013-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
2084299100
|
Plan sponsor’s
address |
222 NORTH SECOND STREET, SUITE 204, BOISE, ID, 83702
|
Signature of
Role |
Plan administrator |
Date |
2018-04-02 |
Name of individual signing |
ASHLEY A. DAVIS |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
DAVIS FAMILY MEDICINE 401(K) PROFIT SHARING PLAN
|
2016
|
680569751
|
2017-04-05
|
ASHLEY A. DAVIS, M.D., P.C.
|
8
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2013-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
2084299100
|
Plan sponsor’s
address |
222 NORTH SECOND STREET, SUITE 204, BOISE, ID, 83702
|
Signature of
Role |
Plan administrator |
Date |
2017-04-05 |
Name of individual signing |
ASHLEY A. DAVIS |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
DAVIS FAMILY MEDICINE 401(K) PROFIT SHARING PLAN
|
2015
|
680569751
|
2016-05-12
|
ASHLEY A. DAVIS, M.D., P.C.
|
9
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2013-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
2084299100
|
Plan sponsor’s
address |
222 NORTH SECOND STREET, SUITE 204, BOISE, ID, 83702
|
Signature of
Role |
Plan administrator |
Date |
2016-05-12 |
Name of individual signing |
ASHLEY A. DAVIS |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
DAVIS FAMILY MEDICINE 401(K) PROFIT SHARING PLAN
|
2014
|
680569751
|
2015-04-06
|
ASHLEY A. DAVIS, M.D., P.C.
|
8
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2013-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
2084299100
|
Plan sponsor’s
address |
222 NORTH SECOND STREET, SUITE 204, BOISE, ID, 83702
|
Signature of
Role |
Plan administrator |
Date |
2015-04-06 |
Name of individual signing |
ASHLEY A. DAVIS |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
DAVIS FAMILY MEDICINE 401(K) PROFIT SHARING PLAN
|
2013
|
680569751
|
2014-05-27
|
ASHLEY A. DAVIS, M.D., P.C.
|
6
|
|
File |
View Page
|
Three-digit plan number (PN) |
001
|
Effective date of plan |
2013-01-01
|
Business code |
621111
|
Sponsor’s telephone number |
2084299100
|
Plan sponsor’s
address |
222 NORTH SECOND STREET, SUITE 204, BOISE, ID, 83702
|
Signature of
Role |
Plan administrator |
Date |
2014-05-27 |
Name of individual signing |
ASHLEY A. DAVIS |
Valid signature |
Filed with authorized/valid electronic signature |
|
|