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  5. MOSCOW FAMILY MEDICINE, P.A.

MOSCOW FAMILY MEDICINE, P.A.

Company Details

Name: MOSCOW FAMILY MEDICINE, P.A.
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 21 Mar 1973 (52 years ago)
Financial Date End: 31 Mar 2020
Date dissolved: 04 Jun 2020
Entity Number: 153180
Place of Formation: IDAHO
File Number: 153180
ZIP code: 83843
County: Latah County
Mailing Address: CEO 623 S MAIN ST MOSCOW, ID 83843-2983

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MOSCOW FAMILY MEDICINE, PA EMPLOYEES' 401K PROFIT SHARING PLAN 2020 820304767 2021-04-28 MOSCOW FAMILY MEDICINE, P.A. 69
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1975-04-01
Business code 621111
Sponsor’s telephone number 2088822011
Plan sponsor’s address 623 S. MAIN STREET, MOSCOW, ID, 83843

Signature of
Role Plan administrator
Date 2021-04-28
Name of individual signing FRANCIS K SPAIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-04-28
Name of individual signing FRANCIS K SPAIN
Valid signature Filed with authorized/valid electronic signature
MOSCOW FAMILY MEDICINE, PA EMPLOYEES' 401K PROFIT SHARING PLAN 2020 820304767 2021-01-28 MOSCOW FAMILY MEDICINE, P.A. 110
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1975-04-01
Business code 621111
Sponsor’s telephone number 2088822011
Plan sponsor’s address 623 S. MAIN STREET, MOSCOW, ID, 83843

Signature of
Role Plan administrator
Date 2021-01-28
Name of individual signing FRANCIS K SPAIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-01-28
Name of individual signing FRANCIS K SPAIN
Valid signature Filed with authorized/valid electronic signature
MOSCOW FAMILY MEDICINE, PA EMPLOYEES' 401K PROFIT SHARING PLAN 2019 820304767 2020-05-21 MOSCOW FAMILY MEDICINE, P.A. 78
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1975-04-01
Business code 621111
Sponsor’s telephone number 2088822011
Plan sponsor’s address 623 S. MAIN STREET, MOSCOW, ID, 83843

Signature of
Role Plan administrator
Date 2020-05-21
Name of individual signing FRANCIS K SPAIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-05-21
Name of individual signing FRANCIS K SPAIN
Valid signature Filed with authorized/valid electronic signature
MOSCOW FAMILY MEDICINE, PA EMPLOYEES' 401K PROFIT SHARING PLAN 2018 820304767 2019-07-23 MOSCOW FAMILY MEDICINE, P.A. 83
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1975-04-01
Business code 621111
Sponsor’s telephone number 2088822011
Plan sponsor’s address 623 S. MAIN STREET, MOSCOW, ID, 83843

Signature of
Role Plan administrator
Date 2019-07-23
Name of individual signing FRANCIS K SPAIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-07-23
Name of individual signing FRANCIS K SPAIN
Valid signature Filed with authorized/valid electronic signature
MOSCOW FAMILY MEDICINE, PA EMPLOYEES' 401K PROFIT SHARING PLAN 2016 820304767 2017-04-05 MOSCOW FAMILY MEDICINE, P.A. 84
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1975-04-01
Business code 621111
Sponsor’s telephone number 2088822011
Plan sponsor’s address 623 S. MAIN, MOSCOW, ID, 83843

Signature of
Role Plan administrator
Date 2017-04-05
Name of individual signing FRANCIS K SPAIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-04-05
Name of individual signing FRANCIS K SPAIN
Valid signature Filed with authorized/valid electronic signature
MOSCOW FAMILY MEDICINE, PA EMPLOYEES' 401K PROFIT SHARING PLAN 2015 820304767 2016-10-03 MOSCOW FAMILY MEDICINE, P.A. 91
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1975-04-01
Business code 621111
Sponsor’s telephone number 2088822011
Plan sponsor’s address 623 S. MAIN, MOSCOW, ID, 83843

Signature of
Role Plan administrator
Date 2016-10-03
Name of individual signing FRANCIS K SPAIN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-10-03
Name of individual signing FRANCIS K SPAIN
Valid signature Filed with authorized/valid electronic signature
MOSCOW FAMILY MEDICINE, PA EMPLOYEES' 401K PROFIT SHARING PLAN 2014 820304767 2015-04-28 MOSCOW FAMILY MEDICINE, P.A. 83
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1975-04-01
Business code 621111
Sponsor’s telephone number 2088822011
Plan sponsor’s address 623 S. MAIN, MOSCOW, ID, 83843

Signature of
Role Plan administrator
Date 2015-04-27
Name of individual signing FRANCIS K SPAIN
Valid signature Filed with authorized/valid electronic signature
MOSCOW FAMILY MEDICINE, PA EMPLOYEES' 401K PROFIT SHARING PLAN 2013 820304767 2014-03-11 MOSCOW FAMILY MEDICINE, P.A. 79
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1975-04-01
Business code 621111
Sponsor’s telephone number 2088822011
Plan sponsor’s address 623 S. MAIN, MOSCOW, ID, 83843

Signature of
Role Plan administrator
Date 2014-03-10
Name of individual signing FRANCIS K SPAIN
Valid signature Filed with authorized/valid electronic signature
MOSCOW FAMILY MEDICINE, PA EMPLOYEES' 401K PROFIT SHARING PLAN 2012 820304767 2013-06-10 MOSCOW FAMILY MEDICINE, P.A. 85
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1975-04-01
Business code 621111
Sponsor’s telephone number 2088822011
Plan sponsor’s address 623 S. MAIN, MOSCOW, ID, 83843

Signature of
Role Plan administrator
Date 2013-06-10
Name of individual signing FRANCIS K SPAIN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
FRANCIS K SPAIN Agent 623 S MAIN ST, MOSCOW, ID 83843

Filing

Filing Name Filing Number Filing date
Dissolution/Revocation - Administrative 0003898079 2020-06-04
Annual Report 0003451525 2019-03-13
Annual Report 0001517111 2018-01-22
Annual Report 0001517146 2017-01-20
Change of Registered Office/Agent/Both (by Entity) 0001517109 2016-01-28
Annual Report 0001517108 2016-01-20
Annual Report 0001517106 2015-01-21
Annual Report 0001517103 2014-01-29
Change of Registered Office/Agent/Both (by Entity) 0001517101 2013-02-11
Annual Report 0001517100 2013-02-05

OSHA's Inspections within Industry

Inspection Nr Report ID Date Opened Site Address
107024622 1032500 1989-09-06 623 S. MAIN, MOSCOW, ID, 83843
Inspection Type Planned
Scope Partial
Safety/Health Health
Close Conference 1989-11-02
Emphasis N: BLOOD
Case Closed 1990-05-21

Violation Items
Citation ID 01001
Citaton Type Serious
Standard Cited 19100132 A
Issuance Date 1989-11-06
Abatement Due Date 1989-11-09
Current Penalty 120.0
Initial Penalty 240.0
Nr Instances 2
Nr Exposed 1
Gravity 06
Citation ID 01002
Citaton Type Serious
Standard Cited 19100141 A04 II
Issuance Date 1989-11-06
Abatement Due Date 1989-11-09
Current Penalty 140.0
Initial Penalty 280.0
Nr Instances 1
Nr Exposed 8
Gravity 07
Citation ID 02001
Citaton Type Other
Standard Cited 19100141 G04
Issuance Date 1989-11-06
Abatement Due Date 1989-11-09
Nr Instances 1
Nr Exposed 18
Gravity 03

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
1099607306 2020-04-28 1094 PPP 623 S Main St, MOSCOW, ID, 83843
Loan Status Date 2021-08-21
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 877877
Loan Approval Amount (current) 877877
Undisbursed Amount 0
Franchise Name -
Lender Location ID 79430
Servicing Lender Name Banner Bank
Servicing Lender Address 10 S First Ave, WALLA WALLA, WA, 99362-1942
Rural or Urban Indicator R
Hubzone Y
LMI N
Business Age Description Existing or more than 2 years old
Project Address MOSCOW, LATAH, ID, 83843-0001
Project Congressional District ID-01
Number of Employees 82
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 79430
Originating Lender Name Banner Bank
Originating Lender Address WALLA WALLA, WA
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 888435.58
Forgiveness Paid Date 2021-07-15

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Date of last update: 01 Apr 2025

Sources: Idaho Secretary of State

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