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KEYSTONE HOSPICE, LLC

Company Details

Name: KEYSTONE HOSPICE, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 13 Oct 2015 (9 years ago)
Financial Date End: 31 Oct 2025
Entity Number: 477943
Place of Formation: IDAHO
File Number: 477943
ZIP code: 83616
County: Ada County
Principal Address: 868 E RIVERSIDE DR STE 170 EAGLE, ID 83616
Mailing Address: 21 N FISHER PARK WAY EAGLE, ID 83616-4796

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
KEYSTONE HOSPICE 401(K) PLAN 2023 475491874 2024-07-01 KEYSTONE HOSPICE 64
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2020-01-01
Business code 623000
Sponsor’s telephone number 2089668181
Plan sponsor’s address 21 N FISHER PARK WAY, EAGLE, ID, 83616

Plan administrator’s name and address

Administrator’s EIN 842925395
Plan administrator’s name 401GO, INC.
Plan administrator’s address 8427 OLD BINGHAM HWY, WEST JORDAN, UT, 84088
Administrator’s telephone number 8012142125

Signature of

Role Plan administrator
Date 2024-07-01
Name of individual signing FIDUCIARY ASSISTANCE
Valid signature Filed with authorized/valid electronic signature
KEYSTONE HOSPICE 401(K) PLAN 2022 475491874 2023-07-31 KEYSTONE HOSPICE 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2020-01-01
Business code 623000
Sponsor’s telephone number 2089668181
Plan sponsor’s address 21 N FISHER PARK WAY, EAGLE, ID, 83616

Plan administrator’s name and address

Administrator’s EIN 842925395
Plan administrator’s name 401GO, INC.
Plan administrator’s address 8427 OLD BINGHAM HWY, WEST JORDAN, UT, 84088
Administrator’s telephone number 8012142125

Signature of

Role Plan administrator
Date 2023-07-31
Name of individual signing FIDUCIARY ASSISTANCE
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
MARIANNE JENSEN Agent 21 N FISHER PARK WAY, EAGLE, ID 83616

Manager

Name Role Address Appointed On
Keystone Hospice, LLC Manager 21 N FISHER PARK WAY, EAGLE, ID 83616 2020-11-23

Managing Member

Name Role Address Appointed On
Leonard Jensen Managing Member 21 N FISHER PARK WAY, EAGLE, ID 83616 2024-11-04

Filing

Filing Name Filing Number Filing date
Annual Report 0005963277 2024-11-04
Annual Report 0005379500 2023-09-03
Annual Report 0004933325 2022-10-03
Annual Report 0004400369 2021-09-03
Annual Report 0004073505 2020-11-23
Annual Report 0003633769 2019-10-01
Annual Report 0002996624 2018-08-29
Annual Report 0002996621 2017-08-23
Statement of Change of Business Mailing Address 0002996620 2017-06-27
Annual Report 0002996618 2016-08-31

Date of last update: 22 Dec 2024

Sources: Idaho Secretary of State