The Good Shepherd Lutheran Home

File	View Page
Three-digit plan number (PN)	002
Effective date of plan	1898-11-01
Business code	623000
Sponsor’s telephone number	5078647714
Plan sponsor’s address	800 HOME ST, PO BOX 747, RUSHFORD, MN, 55971

Plan administrator’s name and address

Administrator’s EIN	410880871
Plan administrator’s name	GOOD SHEPHERD LUTHERAN HOME
Plan administrator’s address	800 HOME ST, PO BOX 747, RUSHFORD, MN, 55971
Administrator’s telephone number	5078647714

Signature of

Role	Plan administrator
Date	2010-09-30
Name of individual signing	RHONDA SPECE
Valid signature	Filed with authorized/valid electronic signature