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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

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
82-0299431 Corporation Unconditional Exemption 555 E PARKCENTER BLVD, BOISE, ID, 83706-6503 1972-11
In Care of Name -
Group Exemption Number 0000
Subsection Civic League, Local Association of Employees, Social Welfare Organization
Affiliation Independent - This code is used if the organization is an independent organization or an independent auxiliary (i.e., not affiliated with a National, Regional, or Geographic grouping of organizations).
Classification Literary Organization, Social Welfare Organization, Labor Organization, Chamber of Commerce, Mutual Cooperative Telephone Co.
Deductibility Contributions are not deductible.
Foundation All organizations except 501(c)(3)
Tax Period 2023-12
Asset 50,000,000 to greater
Income 50,000,000 to greater
Filing Requirement 990 (all other) or 990EZ return
PF Filing Requirement No 990-PF return
Accounting Period Dec
Asset Amount 85966501
Income Amount 91840026
Form 990 Revenue Amount 84836060
National Taxonomy of Exempt Entities -
Sort Name -

Copies of Returns (990, 990-EZ, 990-PF, 990-T)
Organization Name DELTA DENTAL OF IDAHO
EIN 82-0299431
Tax Period 202212
Filing Type E
Return Type 990O
File View File
Organization Name DELTA DENTAL OF IDAHO
EIN 82-0299431
Tax Period 202112
Filing Type E
Return Type 990O
File View File
Organization Name DELTA DENTAL OF IDAHO
EIN 82-0299431
Tax Period 201912
Filing Type E
Return Type 990O
File View File
Organization Name DELTA DENTAL OF IDAHO
EIN 82-0299431
Tax Period 201812
Filing Type P
Return Type 990O
File View File
Organization Name DELTA DENTAL OF IDAHO
EIN 82-0299431
Tax Period 201712
Filing Type E
Return Type 990O
File View File
Organization Name DELTA DENTAL OF IDAHO
EIN 82-0299431
Tax Period 201612
Filing Type E
Return Type 990O
File View File

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: 31 Mar 2025

Sources: Idaho Secretary of State

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