| Name: | KEYSTONE HOSPICE, LLC |
| Jurisdiction: | Idaho |
| Legal type: | Limited Liability Company (D) |
| Status: | Active-Existing |
| Date of registration: | 13 Oct 2015 (10 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 |
| 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 | |||||||||||||||||||||||||||||||
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| 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 |
| 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 |
| Name | Role | Address |
|---|---|---|
| MARIANNE JENSEN | Agent | 21 N FISHER PARK WAY, EAGLE, ID 83616 |
| Name | Role | Address | Appointed On |
|---|---|---|---|
| Keystone Hospice, LLC | Manager | 21 N FISHER PARK WAY, EAGLE, ID 83616 | 2020-11-23 |
| Name | Role | Address | Appointed On |
|---|---|---|---|
| Leonard Jensen | Managing Member | 21 N FISHER PARK WAY, EAGLE, ID 83616 | 2024-11-04 |
| 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 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 5973417107 | 2020-04-14 | 1087 | PPP | 21 N Fisher Park Way, EAGLE, ID, 83616 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 09 Apr 2025
Sources: Idaho Secretary of State
