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  5. DELTA DENTAL PLAN OF IDAHO, INC.

DELTA DENTAL PLAN OF IDAHO, INC.

Company Details

Name: DELTA DENTAL PLAN OF IDAHO, INC.
Jurisdiction: Idaho
Legal type: Non-Profit Corporation (D)
Status: Active-Good Standing
Date of registration: 21 Jun 1971 (54 years ago)
Financial Date End: 30 Jun 2025
Entity Number: 143748
Place of Formation: IDAHO
File Number: 143748
ZIP code: 83706
County: Ada County
Mailing Address: ACCOUNTING 555 E PARKCENTER BLVD BOISE, ID 83706-6503

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DELTA DENTAL 401(K) RETIREMENT SAVINGS PLAN 2021 820299431 2022-10-10 DELTA DENTAL PLAN OF IDAHO, INC. 99
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1985-01-01
Business code 621399
Sponsor’s telephone number 2084893560
Plan sponsor’s address 555 EAST PARKCENTER BLVD, BOISE, ID, 837066503

Signature of
Role Plan administrator
Date 2022-10-10
Name of individual signing WILLIAM SHRUM
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-10-10
Name of individual signing WILLIAM SHRUM
Valid signature Filed with authorized/valid electronic signature
DELTA DENTAL 401(K) RETIREMENT SAVINGS PLAN 2020 820299431 2021-10-15 DELTA DENTAL PLAN OF IDAHO, INC. 89
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1985-01-01
Business code 621399
Sponsor’s telephone number 2084893560
Plan sponsor’s address 555 EAST PARKCENTER BLVD, BOISE, ID, 837066503

Signature of
Role Plan administrator
Date 2021-10-15
Name of individual signing WILLIAM SHRUM
Valid signature Filed with authorized/valid electronic signature
DELTA DENTAL 401(K) RETIREMENT SAVINGS PLAN 2019 820299431 2020-05-05 DELTA DENTAL PLAN OF IDAHO, INC. 89
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1985-01-01
Business code 621399
Sponsor’s telephone number 2084893560
Plan sponsor’s address 555 EAST PARKCENTER BLVD, BOISE, ID, 837066503

Signature of
Role Plan administrator
Date 2020-05-05
Name of individual signing GREG DONACA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-05-01
Name of individual signing GREG DONACA
Valid signature Filed with authorized/valid electronic signature
DELTA DENTAL 401(K) RETIREMENT SAVINGS PLAN 2018 820299431 2019-06-03 DELTA DENTAL PLAN OF IDAHO, INC. 74
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1985-01-01
Business code 621399
Sponsor’s telephone number 2084893560
Plan sponsor’s address 555 EAST PARKCENTER BLVD, BOISE, ID, 837066503

Signature of
Role Plan administrator
Date 2019-06-03
Name of individual signing TERRY PEOPLES
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-06-03
Name of individual signing TERRY PEOPLES
Valid signature Filed with authorized/valid electronic signature
DELTA DENTAL 401(K) RETIREMENT SAVINGS PLAN 2017 820299431 2018-07-17 DELTA DENTAL PLAN OF IDAHO, INC. 81
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1985-01-01
Business code 621399
Sponsor’s telephone number 2084893560
Plan sponsor’s address 555 EAST PARKCENTER BLVD, BOISE, ID, 837066503

Signature of
Role Plan administrator
Date 2018-07-17
Name of individual signing GREG DONACA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-07-17
Name of individual signing GREG DONACA
Valid signature Filed with authorized/valid electronic signature
DELTA DENTAL 401(K) RETIREMENT SAVINGS PLAN 2016 820299431 2017-06-22 DELTA DENTAL PLAN OF IDAHO, INC. 73
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1985-01-01
Business code 621399
Sponsor’s telephone number 2084893528
Plan sponsor’s address 555 EAST PARKCENTER BLVD, BOISE, ID, 83706

Signature of
Role Plan administrator
Date 2017-06-22
Name of individual signing GREG DONACA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-06-22
Name of individual signing GREG DONACA
Valid signature Filed with authorized/valid electronic signature
DELTA DENTAL 401(K) RETIREMENT SAVINGS PLAN 2015 820299431 2016-07-21 DELTA DENTAL PLAN OF IDAHO, INC. 70
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1985-01-01
Business code 621399
Sponsor’s telephone number 2084893528
Plan sponsor’s address 555 EAST PARKCENTER BLVD, BOISE, ID, 83706

Signature of
Role Plan administrator
Date 2016-07-21
Name of individual signing GREG DONACA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-07-21
Name of individual signing GREG DONACA
Valid signature Filed with authorized/valid electronic signature
DELTA DENTAL 401(K) RETIREMENT SAVINGS PLAN 2014 820299431 2015-06-25 DELTA DENTAL PLAN OF IDAHO, INC. 66
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1985-01-01
Business code 621399
Sponsor’s telephone number 2084893528
Plan sponsor’s address 555 EAST PARKCENTER BLVD, BOISE, ID, 83706

Signature of
Role Plan administrator
Date 2015-06-25
Name of individual signing GREG DONACA
Valid signature Filed with authorized/valid electronic signature
DELTA DENTAL 401(K) RETIREMENT SAVINGS PLAN 2013 820299431 2014-07-02 DELTA DENTAL PLAN OF IDAHO, INC. 58
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1985-01-01
Business code 621399
Sponsor’s telephone number 2084893528
Plan sponsor’s address 555 EAST PARKCENTER BLVD, BOISE, ID, 83706

Signature of
Role Plan administrator
Date 2014-07-02
Name of individual signing GREG DONACA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-07-02
Name of individual signing GREG DONACA
Valid signature Filed with authorized/valid electronic signature
DELTA DENTAL 401(K) RETIREMENT SAVINGS PLAN 2012 820299431 2013-07-24 DELTA DENTAL PLAN OF IDAHO, INC. 59
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1985-01-01
Business code 621399
Sponsor’s telephone number 2084893528
Plan sponsor’s address 555 EAST PARKCENTER BLVD, BOISE, ID, 83706

Signature of
Role Plan administrator
Date 2013-07-24
Name of individual signing GREG DONACA
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-07-24
Name of individual signing GREG DONACA
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
GREG DONACA Agent 555 E PARKCENTER BLVD, BOISE, ID 83706

President

Name Role Address Appointed On
Greg Donaca President 555 E. PARKCENTER BLVD., BOISE, ID 83704 2021-05-03

Filing

Filing Name Filing Number Filing date
Annual Report 0005718297 2024-05-03
Annual Report 0005265312 2023-06-05
Application for Reinstatement 0004916152 2022-09-15
Dissolution/Revocation - Administrative 0004915436 2022-09-15
Annual Report 0004263680 2021-05-03
Annual Report 0003863703 2020-05-04
Annual Report 0003517629 2019-05-20
Change of Registered Office/Agent/Both (by Entity) 0001477378 2018-05-11
Annual Report 0001477377 2018-04-30
Annual Report 0001477375 2017-05-11

Related by officers

No related officers

Related by address

ACCOUNTING 555 E PARKCENTER BLVD BOISE, ID 83706-6503

HEALTH SERVICES GROUP, LLC

Date of last update: 01 Dec 2024

Sources: Idaho Secretary of State

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