|
PORTNEUF FAMILY MEDICINE 401(K) PLAN
|
2011
|
611416055
|
2012-07-19
|
PORTNEUF FAMILY MEDICINE
|
11
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2009-01-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
2084787900
|
| Plan sponsor’s
address |
353 N 4TH, POCATELLO, ID, 83201
|
Plan administrator’s name and address
| Administrator’s EIN |
611416055 |
| Plan administrator’s name |
PORTNEUF FAMILY MEDICINE |
| Plan administrator’s
address |
353 N 4TH, POCATELLO, ID, 83201 |
| Administrator’s telephone number |
2084787900 |
Signature of
| Role |
Plan administrator |
| Date |
2012-07-19 |
| Name of individual signing |
RICHARD LASSERE |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2012-07-19 |
| Name of individual signing |
RICHARD LASSERE |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
PORTNEUF FAMILY MEDICINE 401(K) PLAN
|
2010
|
611416055
|
2011-10-12
|
PORTNEUF FAMILY MEDICINE
|
8
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2009-01-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
2084787900
|
| Plan sponsor’s
address |
353 N 4TH, POCATELLO, ID, 83201
|
Plan administrator’s name and address
| Administrator’s EIN |
611416055 |
| Plan administrator’s name |
PORTNEUF FAMILY MEDICINE |
| Plan administrator’s
address |
353 N 4TH, POCATELLO, ID, 83201 |
| Administrator’s telephone number |
2084787900 |
Signature of
| Role |
Plan administrator |
| Date |
2011-10-12 |
| Name of individual signing |
RICHARD J LASSERE, M.D. |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2011-10-12 |
| Name of individual signing |
RICHARD J LASSERE, M.D. |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
PORTNEUF FAMILY MEDICINE 401(K) PLAN
|
2009
|
611416055
|
2010-09-27
|
PORTNEUF FAMILY MEDICINE
|
0
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2009-01-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
2084787900
|
| Plan sponsor’s
address |
353 N 4TH, POCATELLO, ID, 83201
|
Plan administrator’s name and address
| Administrator’s EIN |
611416055 |
| Plan administrator’s name |
PORTNEUF FAMILY MEDICINE |
| Plan administrator’s
address |
353 N 4TH, POCATELLO, ID, 83201 |
| Administrator’s telephone number |
2084787900 |
Signature of
| Role |
Plan administrator |
| Date |
2010-09-27 |
| Name of individual signing |
RICHARD LASSERE |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2010-09-27 |
| Name of individual signing |
RICHARD LASSERE |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
