| Plan Name | MOUNTAIN STATES PROVISIONS INC. |
| Plan identification number | 001 |
| 401k Plan Type | Defined Contribution Pension |
| Plan Features/Benefits |
|
| Company Name: | MOUNTAIN STATES PROVISIONS |
| Employer identification number (EIN): | 201347899 |
| NAIC Classification: | 722300 |
| NAIC Description: | Special Food Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 001 | 2020-01-01 | AMELIA JENSEN | 2021-09-13 | AMELIA JENSEN | 2021-09-13 |
| 001 | 2019-01-01 | AMELIA JENSEN | 2020-10-03 | AMELIA JENSEN | 2020-10-03 |
| 001 | 2018-01-01 | AMELIA JENSEN | 2019-07-17 | AMELIA JENSEN | 2019-07-17 |
| 001 | 2017-01-01 | AMELIA JENSEN | 2018-09-25 | AMELIAJENSEN | 2018-09-25 |
| 001 | 2016-01-01 | AMELIA JENSEN | 2017-10-16 | AMELIAJENSEN | 2017-10-16 |