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  5. VALLEY FACIAL PLASTICS & ENT, PA

VALLEY FACIAL PLASTICS & ENT, PA

Company Details

Name: VALLEY FACIAL PLASTICS & ENT, PA
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Active-Good Standing
Date of registration: 27 Dec 1976 (48 years ago)
Financial Date End: 31 Dec 2024
Entity Number: 175770
Place of Formation: IDAHO
File Number: 175770
ZIP code: 83501
County: Nez Perce County
Mailing Address: ZINA WEBSTER 330 WARNER DR LEWISTON, ID 83501-4441

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
VALLEY FACIAL PLASTICS & ENT, PA 401(K) PLAN 2023 820329344 2024-09-23 VALLEY FACIAL PLASTICS & ENT, PA 20
File View Page
Three-digit plan number (PN) 006
Effective date of plan 2004-01-13
Business code 621111
Sponsor’s telephone number 2087460193
Plan sponsor’s address 330 WARNER DRIVE, LEWISTON, ID, 83501

Signature of
Role Plan administrator
Date 2024-09-23
Name of individual signing KARNA BURRY
Valid signature Filed with authorized/valid electronic signature
VALLEY FACIAL PLASTICS & ENT, PA 401(K) PLAN 2022 820329344 2023-10-09 VALLEY FACIAL PLASTICS & ENT, PA 19
File View Page
Three-digit plan number (PN) 006
Effective date of plan 2004-01-13
Business code 621111
Sponsor’s telephone number 2087460193
Plan sponsor’s address 330 WARNER DRIVE, LEWISTON, ID, 83501

Signature of
Role Plan administrator
Date 2023-10-09
Name of individual signing SENNETT PIERCE
Valid signature Filed with authorized/valid electronic signature
VALLEY FACIAL PLASTICS & ENT, PA 401(K) PLAN 2021 820329344 2022-06-23 VALLEY FACIAL PLASTICS & ENT, PA 14
File View Page
Three-digit plan number (PN) 006
Effective date of plan 2004-01-13
Business code 621111
Sponsor’s telephone number 2087460193
Plan sponsor’s address 330 WARNER DRIVE, LEWISTON, ID, 83501

Signature of
Role Plan administrator
Date 2022-06-23
Name of individual signing ZINA WEBSTER
Valid signature Filed with authorized/valid electronic signature
VALLEY FACIAL PLASTICS & ENT, PA 401K PLAN 2020 820329344 2021-03-09 VALLEY FACIAL PLASTICS & ENT, PA 15
File View Page
Three-digit plan number (PN) 006
Effective date of plan 2004-01-13
Business code 621111
Sponsor’s telephone number 2087460193
Plan sponsor’s address 330 WARNER DR, LEWISTON, ID, 835014441

Signature of
Role Plan administrator
Date 2021-03-09
Name of individual signing JEFF BURRY
Valid signature Filed with authorized/valid electronic signature
VALLEY FACIAL PLASTICS & ENT, PA 401K PLAN 2019 820329344 2020-01-30 VALLEY FACIAL PLASTICS & ENT, PA 15
File View Page
Three-digit plan number (PN) 006
Effective date of plan 2004-01-13
Business code 621111
Sponsor’s telephone number 2087460193
Plan sponsor’s address 330 WARNER DR, LEWISTON, ID, 835014441

Signature of
Role Plan administrator
Date 2020-01-30
Name of individual signing JEFF BURRY
Valid signature Filed with authorized/valid electronic signature
VALLEY FACIAL PLASTICS & ENT, PA 401K PLAN 2018 820329344 2019-08-21 VALLEY FACIAL PLASTICS & ENT, PA 12
File View Page
Three-digit plan number (PN) 006
Effective date of plan 2004-01-13
Business code 621111
Sponsor’s telephone number 2087460193
Plan sponsor’s address 330 WARNER DR, LEWISTON, ID, 835014441

Signature of
Role Plan administrator
Date 2019-08-21
Name of individual signing JEFF BURRY
Valid signature Filed with authorized/valid electronic signature
VALLEY FACIAL PLASTICS & ENT, PA 401K PLAN 2017 820329344 2018-06-11 VALLEY FACIAL PLASTICS & ENT, PA 12
File View Page
Three-digit plan number (PN) 006
Effective date of plan 2004-01-13
Business code 621111
Sponsor’s telephone number 2087460193
Plan sponsor’s address 330 WARNER DR, LEWISTON, ID, 835014441

Signature of
Role Plan administrator
Date 2018-06-11
Name of individual signing JEFF BURRY
Valid signature Filed with authorized/valid electronic signature
VALLEY FACIAL PLASTICS & ENT, PA 401K PLAN 2016 820329344 2017-09-18 VALLEY FACIAL PLASTICS & ENT, PA 14
File View Page
Three-digit plan number (PN) 006
Effective date of plan 2004-01-13
Business code 621111
Sponsor’s telephone number 2087460193
Plan sponsor’s address 330 WARNER DR, LEWISTON, ID, 835014441

Signature of
Role Plan administrator
Date 2017-09-18
Name of individual signing JEFF BURRY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-09-18
Name of individual signing JEFF BURRY
Valid signature Filed with authorized/valid electronic signature
VALLEY FACIAL PLASTICS & ENT, PA 401K PLAN 2015 820329344 2016-06-14 VALLEY FACIAL PLASTICS & ENT, PA 15
File View Page
Three-digit plan number (PN) 006
Effective date of plan 2004-01-13
Business code 621111
Sponsor’s telephone number 2087460193
Plan sponsor’s address 330 WARNER DR, LEWISTON, ID, 835014441

Plan administrator’s name and address
Administrator’s EIN 820329344
Plan administrator’s name VALLEY FACIAL PLASTICS & ENT, PA
Plan administrator’s address 330 WARNER DR, LEWISTON, ID, 835014441
Administrator’s telephone number 2087460193

Signature of
Role Plan administrator
Date 2016-06-14
Name of individual signing JEFF BURRY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-06-14
Name of individual signing JEFF BURRY
Valid signature Filed with authorized/valid electronic signature
VALLEY FACIAL PLASTICS & ENT, PA 401K PLAN 2014 820329344 2015-05-26 VALLEY FACIAL PLASTICS & ENT, PA 14
File View Page
Three-digit plan number (PN) 006
Effective date of plan 2004-01-13
Business code 621111
Sponsor’s telephone number 2087460193
Plan sponsor’s address 330 WARNER DR, LEWISTON, ID, 835014441

Plan administrator’s name and address
Administrator’s EIN 820329344
Plan administrator’s name VALLEY FACIAL PLASTICS & ENT, PA
Plan administrator’s address 330 WARNER DR, LEWISTON, ID, 835014441
Administrator’s telephone number 2087460193

Signature of
Role Plan administrator
Date 2015-05-26
Name of individual signing JEFF BURRY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-05-26
Name of individual signing JEFF BURRY
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
JEFF D BURRY DO Agent 330 WARNER DRIVE, LEWISTON, ID 83501

Filing

Filing Name Filing Number Filing date
Annual Report 0005456470 2023-11-03
Annual Report 0003660102 2019-11-01
Application for Reinstatement 0003484500 2019-04-19
Dissolution/Revocation - Administrative 0003480885 2019-04-16
Annual Report 0001616657 2018-01-15
Annual Report 0001616655 2016-11-03
Annual Report 0001616653 2015-10-28
Annual Report 0001616651 2014-11-05
Annual Report 0001616634 2013-12-03
Legacy Amendment 0000773825 2013-09-04

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Date of last update: 16 Jan 2025

Sources: Idaho Secretary of State

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