|
POUDRE VALLEY HEALTH CARE, INC. 403(B) PLAN
|
2013
|
841262971
|
2014-08-28
|
POUDRE VALLEY HEALTH CARE, INC.
|
18
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
002
|
| Effective date of plan |
1987-01-01
|
| Business code |
622000
|
| Sponsor’s telephone number |
9704957300
|
| Plan
sponsor’s DBA name |
POUDRE VALLEY HOSPITAL
|
| Plan sponsor’s mailing address |
1024 LEMAY, FORT COLLINS, CO, 80524
|
| Plan sponsor’s
address |
1024 LEMAY, FORT COLLINS, CO, 80524
|
Number of participants as of the end of the plan year
| Active participants |
0 |
| Retired or separated participants receiving
benefits |
0 |
| Other
retired or separated participants entitled to future benefits |
0 |
| Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
| Number of
participants
with
account balances as of the end of the plan year |
0 |
Signature of
| Role |
Plan administrator |
| Date |
2014-08-28 |
| Name of individual signing |
STACYE FURMANEK |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2014-08-28 |
| Name of individual signing |
STACYE FURMANEK |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
POUDRE VALLEY HEALTH CARE, INC. 403(B) PLAN
|
2012
|
841262971
|
2013-10-10
|
POUDRE VALLEY HEALTH CARE, INC.
|
54
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
002
|
| Effective date of plan |
1987-01-01
|
| Business code |
622000
|
| Sponsor’s telephone number |
9704957300
|
| Plan
sponsor’s DBA name |
POUDRE VALLEY HOSPITAL
|
| Plan sponsor’s mailing address |
1024 SOUTH LEMAY AVENUE, FORT COLLINS, CO, 805243929
|
| Plan sponsor’s
address |
1024 SOUTH LEMAY AVENUE, FORT COLLINS, CO, 805243929
|
Number of participants as of the end of the plan year
| Active participants |
15 |
| Other
retired or separated participants entitled to future benefits |
3 |
| Number of
participants
with
account balances as of the end of the plan year |
18 |
| Number of participants that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
0 |
Signature of
| Role |
Plan administrator |
| Date |
2013-10-10 |
| Name of individual signing |
STACYE FURMANEK |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2013-10-10 |
| Name of individual signing |
STACYE FURMANEK |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
POUDRE VALLEY HEALTH CARE, INC. 403(B) PLAN
|
2011
|
841262971
|
2012-06-26
|
POUDRE VALLEY HEALTH CARE, INC.
|
57
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
002
|
| Effective date of plan |
1987-01-01
|
| Business code |
622000
|
| Sponsor’s telephone number |
9704957300
|
| Plan
sponsor’s DBA name |
POUDRE VALLEY HOSPITAL
|
| Plan sponsor’s mailing address |
1024 SOUTH LEMAY AVENUE, FORT COLLINS, CO, 805243929
|
| Plan sponsor’s
address |
1024 SOUTH LEMAY AVENUE, FORT COLLINS, CO, 805243929
|
Plan administrator’s name and address
| Administrator’s EIN |
841262971 |
| Plan administrator’s name |
POUDRE VALLEY HEALTH CARE, INC. |
| Plan administrator’s
address |
1024 SOUTH LEMAY AVENUE, FORT COLLINS, CO, 805243929 |
| Administrator’s telephone number |
9704957300 |
Number of participants as of the end of the plan year
| Active participants |
30 |
| Other
retired or separated participants entitled to future benefits |
24 |
| Number of
participants
with
account balances as of the end of the plan year |
54 |
| Number of participants that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
0 |
Signature of
| Role |
Plan administrator |
| Date |
2012-06-26 |
| Name of individual signing |
STACYE FURMANEK |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
POUDRE VALLEY HEALTH CARE, INC. 403(B) PLAN
|
2010
|
841262971
|
2011-10-10
|
POUDRE VALLEY HEALTH CARE, INC.
|
57
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
002
|
| Effective date of plan |
1987-01-01
|
| Business code |
622000
|
| Sponsor’s telephone number |
9704957300
|
| Plan
sponsor’s DBA name |
POUDRE VALLEY HOSPITAL
|
| Plan sponsor’s mailing address |
1024 SOUTH LEMAY AVENUE, FORT COLLINS, CO, 805243929
|
| Plan sponsor’s
address |
1024 SOUTH LEMAY AVENUE, FORT COLLINS, CO, 805243929
|
Plan administrator’s name and address
| Administrator’s EIN |
841262971 |
| Plan administrator’s name |
POUDRE VALLEY HEALTH CARE, INC. |
| Plan administrator’s
address |
1024 SOUTH LEMAY AVENUE, FORT COLLINS, CO, 805243929 |
| Administrator’s telephone number |
9704957300 |
Number of participants as of the end of the plan year
| Active participants |
52 |
| Retired or separated participants receiving
benefits |
0 |
| Other
retired or separated participants entitled to future benefits |
0 |
| Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
| Number of
participants
with
account balances as of the end of the plan year |
52 |
Signature of
| Role |
Plan administrator |
| Date |
2011-10-10 |
| Name of individual signing |
STACYE FURMANEK |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
POUDRE VALLEY HEALTH CARE, INC. 403(B) PLAN
|
2009
|
841262971
|
2011-10-10
|
POUDRE VALLEY HEALTH CARE, INC.
|
93
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
002
|
| Effective date of plan |
1987-01-01
|
| Business code |
622000
|
| Sponsor’s telephone number |
9704957300
|
| Plan
sponsor’s DBA name |
POUDRE VALLEY HOSPITAL
|
| Plan sponsor’s mailing address |
1024 SOUTH LEMAY AVENUE, FORT COLLINS, CO, 805243929
|
| Plan sponsor’s
address |
1024 SOUTH LEMAY AVENUE, FORT COLLINS, CO, 805243929
|
Plan administrator’s name and address
| Administrator’s EIN |
841262971 |
| Plan administrator’s name |
POUDRE VALLEY HEALTH CARE, INC. |
| Plan administrator’s
address |
1024 SOUTH LEMAY AVENUE, FORT COLLINS, CO, 805243929 |
| Administrator’s telephone number |
9704957300 |
Number of participants as of the end of the plan year
| Active participants |
57 |
| Retired or separated participants receiving
benefits |
0 |
| Other
retired or separated participants entitled to future benefits |
0 |
| Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
| Number of
participants
with
account balances as of the end of the plan year |
57 |
Signature of
| Role |
Plan administrator |
| Date |
2011-10-10 |
| Name of individual signing |
STACYE FURMANEK |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
